What Is Suboxone?       

Suboxone is a combination medication that has buprenorphine and naloxone to help a person suffering from opioid addiction.1 Doctors prescribe Suboxone to those struggling with addiction because it provides a pathway to stop using drugs illegally without experiencing the strong side effects that can come from withdrawing from opioids. People take Suboxone as part of medication-assisted treatment. They will usually see a doctor regularly to ensure they’re taking their Suboxone effectively. They also usually participate in therapy, 12-step programs, or other services that help a person break the mental addiction to opioids. Through Suboxone, thousands of people have been able to more safely stop using opioids and start getting clean.

How Does Suboxone Work?  

Suboxone contains two medications: buprenorphine and naloxone. Understanding how each component works can provide insight as to how it helps a person overcome addiction.

To understand how addiction and the medicine works, imagine an opioid receptor in the brain that acts like an on/off switch. An agonist medication turns the switch to “on” while an antagonist turns it to “off.” Opioids like heroin and narcotic pain medications are full agonists. They turn the switch on, and that leads to some positive aspects like pain relief. However, it also leads to euphoria that can become addictive as well as slowed respiratory rate that can lead to overdose and death. 1

Buprenorphine

Buprenorphine is a partial opioid agonist. This means that it doesn’t cause all the effects of an opioid agonist. In this case, it can reduce withdrawal symptoms without causing the addictive euphoria. 1 It’s also less likely to cause respiratory depression, so it’s not as deadly as opioids can be. However, buprenorphine is different from another medication-assisted treatment called methadone because it doesn’t relieve chronic pain. 1

Naloxone

Naloxone is the second component of Suboxone. 1 It’s present in a smaller amount than buprenorphine in the medication. Naloxone is an opioid antagonist. This means that it keeps the switch for opioid receptors off. While it may seem like naloxone and buprenorphine would oppose each other in the body, they actually work together well for addiction. That’s because naloxone helps to prevent the addictive euphoria narcotics can cause.

Naloxone also reduces the likelihood that someone will inject Suboxone. If a person were to inject Suboxone, the naloxone would be more available in the body and would cause more immediate opioid withdrawal symptoms. This could be very unpleasant and painful. 2 However, the body doesn’t absorb the oral naloxone form as much. Therefore, taking it orally doesn’t cause the same withdrawal symptoms. If a person tries to take a lot of Suboxone, the naloxone will also be present in higher amounts and potentially cause withdrawal symptoms. As a result, the addition of naloxone can deter a lot of people from using Suboxone in the wrong ways.

The medication is available both in pill form and also as a film that dissolves when placed on the tongue. A person will usually take Suboxone once a day in the initial period of use. 1

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What Are the Side Effects of Suboxone? 

While Suboxone is safer than narcotic pain medications and heroin, it isn’t without side effects. 1 A person can also overdose on Suboxone if they take too much. This is why doctors must receive special training in addiction medicine before they can prescribe it, and a person must participate in a Suboxone monitoring program to ensure they’re abstaining from using opioids and using Suboxone safely.

Some of the more common, yet unpleasant, side effects of Suboxone can include1 :

  • constipation
  • headache
  • problems going to sleep/staying asleep
  • stomach pain
  • sweating
  • vomiting

If these symptoms don’t go away within a few days of starting Suboxone, a person should talk to their doctor.

Severe Symptoms

In rare cases, Suboxone can cause symptoms that are more severe that may require immediate medical attention. These include:

  • flu-like symptoms
  • itching
  • problems breathing
  • skin rash
  • upset stomach
  • yellowing of the skin or eyes

Because the liver metabolizes Suboxone, it’s important that a person with liver problems doesn’t take Suboxone or possibly takes a smaller dose. Those who abuse alcohol may not be candidates to take Suboxone as the alcohol and Suboxone combined could cause significant liver inflammation and scarring. 1

Overdose Warning

A person can overdose on Suboxone. Signs of a Suboxone overdose include 1 :

  • anxiety
  • difficulty concentrating
  • dizziness/loss of consciousness
  • seizures
  • slow heartbeat
  • stomach pain and upset

A person should call 911 and seek emergency treatment if they think they or a friend has overdosed on Suboxone.

How Is Taking Suboxone Different From Methadone?

Suboxone and methadone are two examples of MAT approaches to help a person stop taking opioids and start taking a medication that’s safer when used the right ways. 2 Methadone is a schedule II drug that has a long history of use in helping people overcome their addiction to heroin and other opioids.

Methadone is different in several key ways than Suboxone. These include: 2

  • Methadone’s structure means it is also used as a pain medication. People with chronic pain who struggle with addiction are typically prescribed methadone. Suboxone won’t relieve chronic pain, but is used to treat opioid addiction by reducing withdrawal symptoms.
  • Methadone requires more frequent monitoring, including bloodwork. Methadone is very long-lasting in the body. In order for a person to participate in a methadone program, they must receive their methadone at a clinic, and may have to have bloodwork done to ensure the methadone isn’t building up too much in their body.
  • Methadone is a schedule II drug while Suboxone is a schedule III drug. Both can be addictive, but historically methadone has proven more addictive2
  • Methadone is traditionally much cheaper than Suboxone2 It’s a drug that has been on the market since 1947 and has generic formulations that are less expensive than Suboxone. In 2002, the FDA approved buprenorphine for the use of treating opioid dependence. 4

According to an article published in the journal Evidence-Based Practice, methadone and Suboxone are “about the same in efficacy”. 3 However, there are more areas and physicians that prescribe Suboxone than when compared to the availability of methadone clinics.

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How Effective Is Suboxone? 

According to an analysis regarding existing studies of Suboxone’s effectiveness published in the Journal of Psychiatry: Several recent studies have shown that Suboxone is a medically and cost-effective treatment for heroin addiction. 4 A growing number of Suboxone prescriptions are issued each year.
According to the journal, there were: 4
  • 12,000 Suboxone prescriptions in 2002
  • 300,000 Suboxone prescriptions in 2006
The number of prescriptions continue to climb.
Researchers have studied the effectiveness of Suboxone versus placebo drugs as well as Suboxone versus other existing MAT medications.4 These include buprenorphine alone, clonidine, and methadone. Some of the key findings include: 4
  • One study of 326 participants who took Suboxone, buprenorphine alone, or a placebo found that Suboxone and buprenorphine were associated with more opioid-negative urine samples and fewer reported cravings than people who took a placebo. 4
  • Another study that compared a 13-day opioid detoxification program with Suboxone to clonidine found 77 percent of patients treated with Suboxone provided negative samples after 13 days while 22 percent of those treated with clonidine provided negative samples. 4
Researchers have also conducted studies as to an effective time period for taking Suboxone. According to the Journal of Psychiatry, some of the following key findings regarding Suboxone over time include: 4
  • A study comparing a 5-day buprenorphine treatment of 2 milligrams per day compared to a 30-day Suboxone treatment program with a daily dose of about 16 milligrams of buprenorphine and 4 milligrams of naloxone found the longer program was more successful in achieving opioid abstinence. 4
  • Another study comparing 7-day and 28-day regimens of Suboxone tapering after a stabilization period didn’t find a difference in relapse rates with either approach.4 This means that a person once stabilized can usually stop taking Suboxone fairly quickly , if desired. A person is considered to be in the stabilization phase when they no longer have withdrawal symptoms from stopping opioid abuse.
The article recommends that patients at high risk for relapse remain on Suboxone treatment for at least a year to reduce the risks for relapse. Examples of patients at high risk for relapse include those with a history of: 4
    • childhood sexual abuse or neglect
    • chronic pain
    • have a history of substance abuse that includes several abstinence and relapse phases
    • mental illness
When taken correctly and for a sufficient length of time, Suboxone has proven effective in treating opioid addiction.

What Is Treatment With Suboxone Like?

Treatment with Suboxone isn’t as simple as stopping taking one pill and starting taking another. A doctor must have significant training in Suboxone administration because of the timing elements that are crucial to helping a person avoid strong withdrawal symptoms. 5

When a person takes Suboxone, the medication will “knock off” any other opioids that are on the receptors. The result can be prominent withdrawal symptoms. As a result, a doctor will recommend starting taking Suboxone when a person has at least partially withdrawn from the substances they currently abuse, but not fully withdrawn. The result minimizes the withdrawal effects from the substance they abuse without having Suboxone cause dramatic side effects itself.

With this in mind, most doctors will recommend a multi-step approach to taking Suboxone. This includes an induction (start) phase, stabilization, and tapering/maintenance phases.5

Induction Phase

The induction phase begins when a person is in what’s known as “precipitated withdrawal”. 5 This is when enough of an opiate has left the receptor such that Suboxone won’t cause adverse side effects when a person takes it. Doctors have different scales and evaluation tools they can use to determine if a person is ready to start taking Suboxone. A lot of the timing depends on the drug a person abuses. For example, methadone is very long-lasting in the body while heroin is short-acting. 5 A person can expect they will experience some withdrawal symptoms, such as sweating, stomach cramps, muscles aches, or agitation. When they start taking Suboxone, these symptoms will get better.

The steps of the induction phase depend on if a person is taking Suboxone on an outpatient basis or inpatient one. 5 For example, a person taking Suboxone on an inpatient basis will usually go to their doctor’s office at least twice a week in the first week they take the medication. They will be expected to provide urine samples regularly to ensure they are still opioid-free.

During this time, a person is also encouraged to participate in counseling as well as support groups, such as Narcotics Anonymous.

Stabilization Phase

A person will start to move into the stabilization phase as they continue to take the medication and the former drugs they used have left their body. 5 Sometimes, after about a week or more of taking Suboxone, it can be easy to feel as if a person is “healed” and doesn’t need Suboxone any more. It’s important to remember that the Suboxone prevented withdrawal symptoms. However, suddenly stopping Suboxone can cause withdrawal symptoms too. Also, it’s best a person also takes enough time in therapy to start the process of beating the mental addiction to opioids. 5

After a certain amount of time, a doctor may recommend tapering the amount of Suboxone a person uses. A person will usually start reducing their dosage over the course of several months. According to the National Alliance of Advocates for Buprenorphine Treatment, studies show that the longer a person is maintained on Suboxone, the more likely they are to remain abstinent from opioid abuse. 5

How Do I Find a Suboxone Treatment Provider?

Not all doctors can prescribe Suboxone. They must go through a special training program and limit their patients to a certain amount who take Suboxone so they can manage their care. If interested in learning more about taking Suboxone, anyone can visit Suboxone.com and click on “Find a Treatment Provider” to view a list of providers in their area who offer Suboxone treatments. They can also call the 1-866-973-4373 to talk to a representative from Suboxone who can help them identify a nearby treatment provider.

Suboxone is a MAT approach that has proven to help those struggling with opioid abuse overcome their addictions. It can be just as effective as methadone therapy in treating addiction. However, a person must go through an authorized provider to begin treatment. If you are wondering if Suboxone therapy could benefit you or someone you love, talk to your rehabilitation counselor, doctor, or therapist about Suboxone.

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