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Suboxone Overview

Jul 26, 2008 - 2 comments

Treating Opioid Dependence

Dependence on opioids – prescription painkillers and heroin – has been defined as a long-term brain disease by the World Health Organization and the National Institute on Drug Abuse.  This disease is caused by changes in the chemistry of the brain.  Although it is often not recognized, admitted, or understood, it is a disease that can be treated with medication together with counseling.  This medical condition strikes people at all ages and in all walks of life.

Since 2000, when the Drug Addiction Treatment Act (DATA) was passed by Congress, patients with this serious, long-term disease may be treated right in a doctor’s office and through take-home prescriptions using Suboxone.  Daily visits for treatment are not necessary after the patient’s dose has been established.  In-office treatment with Suboxone offers patients privacy, convenience, and confidentiality.
WHAT IS SUBOXONE?

suboxone® C-III (buprenorphine HCI/naloxone HCI dehydrate sublingual tablets) is a medicine that, together with counseling, is approved to treat opioid dependence in a doctor’s office and with take-home prescriptions.  Buprenorphine has unique characteristics that can help many patients manage their dependence and remain in treatment.

The key difference between buprenorphine and other opioids is that buprenorphine is a “partial opioid agonist.”  This means that the medicine attaches to the same spots in the brain (receptors) that any other opioid would attach to, but it does not create the same level of activity as “full opioid agonists” do (prescription painkillers, heroin, or methadone).  Basically, at the right doses buprenorphine minimizes withdrawal symptoms, decreases cravings, and partially blocks the effects of other opioids.

How Does Treatment with Suboxone Work?

When a doctor starts an opioid-dependent patient on Suboxone, the patient must be experiencing mild to moderate withdrawal.  At this point, the opioids from prescription painkillers or heroin have begun to leave the brain’s opioid receptors.  As the opioids come off the receptors, buprenorphine moves onto and sticks to them.  The patient’s withdrawal symptoms get better as the receptors fill up with buprenorphine, and Suboxone begins to suppress withdrawal symptoms and cravings.


Suboxone attaches to the receptors and partially blocks the effects of other opioids.  It is as if Suboxone takes up the opioid parking spaces in the brain, making it very difficult for other opioids to park there.  With daily maintenance doses, Suboxone continues to keep the brain’s opioid receptors occupied.  Even if the patient uses another opioid at this point, the effects of that opioid will be greatly reduced.

How Does Suboxone Help Patients?



When Suboxone moves onto the opioid receptors in a dependent patient’s brain, it does four important things.



First, by binding to the brain’s opioid receptors, Suboxone satisfies the dependent person’s need for an opioid.  This suppresses withdrawal symptoms and drug cravings.
Second, because Suboxone excites the brain’s opioid receptors only a little – it is a partial agonist – the patient does not get the same strong effects that are caused by full agonists such as prescription painkillers, heroin, and methadone.  It is as though buprenorphine takes the physical aspects of dependence – the brain’s need for the drug to feel satisfied and to prevent withdrawal – off the table.
Third, Suboxone sticks to the brain’s receptors so that other opioids have great difficulty attaching, and it remains on the receptors for several days.
Finally, although all opioids lower breathing, when Suboxone is taken alone and as directed, it has an upper limit on how much it does this.  This limitation is because buprenorphine is a partial agonist.  Although full agonists (opioid painkillers, heroin, methadone) continue to lower breathing as a person takes more of the drug, Suboxone’s “ceiling effect” makes an overdose death from lowered breathing unlikely, when buprenorphine is used by itself.


Even with this safety feature, however, patients should be very careful about taking Suboxone while also taking other sedatives, especially benzodiazepines.  This is because the sedating effects of the buprenorphine will add on to the sedating effects of the other drugs, and the combination may become dangerous.  In particular, grinding up Suboxone (which is meant to be dissolved under the tongue) and mixing it with benzodiazepines for injection has caused deaths.  Patients being treated with buprenorphine also should not use tranquilizers, antidepressants, or sedatives except under a doctor’s orders, and they should avoid alcohol.



What is the Difference Between Suboxone and Subutex?

Both Suboxone and Subutex contain buprenorphine and are meant to be dissolved under the tongue.  The difference between them is that Suboxone also contains naloxone, a drug that will cause severe withdrawal if a patient uses Suboxone incorrectly (such as by grinding it up and injecting it).  When Suboxone is used correctly, very little naloxone enters the bloodstream and as a result the naloxone has no effect.  It is included in Suboxone to reduce the chance that the product will be misused.  In the United States, Suboxone is the form of buprenorphine that is prescribed most often.

PATIENTS’ QUESTIONS

How Do I Start Suboxone Therapy?

Any doctor may take the training to become certified to prescribe Suboxone.  As a first step, ask your doctor if he or she is certified to treat you.  If yes, you can ask how to get started in that office.  If no, you can tell your doctor where to find information online about becoming certified (opioiddependence.com, Suboxone.com or buprenorphine.samhsa.gov).  you can also ask for a referral to another doctor in your area who can prescribe Suboxone, and discuss how your doctor will monitor your progress.  Additionally, many certified physicians are listed on the Physician Locator at buprenorphine.samhsa.gov/bwns_locator/index.html or at suboxone.com.  Dr. Heather Rohrer at Sutton Place is certified to prescribe Suboxone.

Once you have scheduled an appointment to begin Suboxone therapy, your doctor will ask you to arrive in a state of mild to moderate withdrawal.  In order to provide the best treatment for you, your doctor or nurse will probably ask you detailed questions about your history of substance abuse.  The doctor may also draw blood or take a urine sample.  This information will always be kept strictly confidential.
Why Do I Need to be in Withdrawal?

When you take your first dose of Suboxone, you need to be experiencing mild to moderate withdrawal so that the buprenorphine can move onto the brain’s opioid receptors as the other opioids come off.  During this phase, your brain’s opioid receptors will fill with buprenorphine and your symptoms (cravings, withdrawal) will become controlled.  Suboxone will also largely block other opioids from attaching.  Moving you onto Suboxone is called “induction.”  Induction can take one to seven days, and you will be under a doctor’s close supervision during that time.

What Happens After I Get Started on Suboxone?

Once you have been inducted onto Suboxone and have stabilized, your doctor will decide what the best daily dose of Suboxone is for you. You will then begin maintenance therapy with a consistent dose of medicine, and your withdrawal symptoms will be relieved and your cravings reduced or gone altogether.  Every patient’s needs are different, and most doctors will tailor the length of time that the patient remains on maintenance to the individual’s needs.  In most cases you will be able to take your maintenance therapy at home.  Your doctor may decide to see you less often at this point and may discuss appropriate counseling options with you.

Although you won’t need to see a healthcare worker every day to receive your medicine, it is still very important for you to keep in contact with your doctor.  When you do see your doctor, he or she may request urine samples to see how well Suboxone is working for you.  Tell your doctor if you experience withdrawal symptoms, since this could mean you need to have your dose adjusted.

During the maintenance phase, you and your doctor may want to talk about counseling options.  Many patients and their doctors find that treatment for opioid dependence works best when medical treatment with Suboxone is combined with counseling.

How Long Will I Stay on Suboxone?

The length of therapy will depend on your needs, and is up to you, your doctor, and possibly your counselor.  Some patients need Suboxone for as little as a few weeks, while others may need it for months or even years.  Combining Suboxone treatment with counseling may increase your chances of success.

For some patients, short-term treatment with Suboxone may not allow enough time to deal with the emotional and behavioral parts of their disease.  Physical dependence is only part of the picture.  The risk of relapse often is higher with short-term treatment since patients may not have had enough time to learn how to maintain a drug-free lifestyle.

Don’t stop taking Suboxone on your own.  Stopping abruptly can cause withdrawal symptoms.  When you do come off Suboxone, your doctor will work with you to lower the dose gradually until you are comfortable without Suboxone.  When you finally stop taking Suboxone, throw away any leftover pills so they can’t be used by anyone else.

Can I Overdose on Suboxone?
As noted above, although all opioids lower breathing, when Suboxone is taken alone and as directed, it has an upper limit on how much it does this.  This limitation is because buprenorphine is a partial agonist.  Although full agonists (opioid painkillers, heroin, methadone) continue to lower breathings as a person takes more of the drug, Suboxone’s “ceiling effect” makes an overdose death from lowered breathing unlikely, when buprenorphine is used by itself.

Even with this safety feature, however, patients should be very careful about taking Suboxone while also taking other sedatives, especially benzodiazepines.  This is because the sedating effects of the buprenorphine will add on to the sedating effects of the other drugs, and the combination may become dangerous.  In particular, grinding up Suboxone (which is meant to be dissolved under the tongue) and mixing it with benzodiazepines for injection has caused deaths.  Patients being treated with buprenorphine also should not use tranquilizers, antidepressants, or sedatives except under a doctor’s orders, and they should avoid alcohol.


If I’m Taking Methadone, Can I Switch to Suboxone?

It is important to discuss all treatment options with your doctor.  If you are currently taking methadone, it is possible for you to switch to Suboxone.  However, many patients are treated successfully with methadone.  Everyone’s situation is different, and you and your doctor should work together to determine what is best for you.

Doesn’t Suboxone Just Replace One Drug for Another?


Yes and no.  Suboxone of course is a drug, and you use it to help free your body of the need for other opioid drugs such as prescription painkillers or heroin.  However, because Suboxone is a partial opioid agonist, its unique features allow you to reduce or avoid withdrawal and cravings while at the same time largely blocking the effects of other opioids.

Studies have shown that people taking Suboxone tend to improve their chances of success with non-drug therapies, Suboxone patients generally are better able to focus on their counseling and recovery because they are not distracted by cravings and withdrawal symptoms.  Managing the physical symptoms of the disease can allow you to gain control of your dependence.

Is Suboxone Safe?

Like all medications, Suboxone does have side effects.  These are mild and generally subside after a few weeks.  Side effects can include: headache, withdrawal symptoms, body pain, nausea, insomnia, sweating, constipation, and stomach pain.

Let your doctor know if you experience these before or during your treatment with Suboxone.  He or she may be able to treat some of these symptoms.  There are limited studies to support the use of Suboxone in pregnant women.  You must tell your doctor if you are pregnant or become pregnant while taking Suboxone.  Your doctor will need to decide if the benefit of using Suboxone outweighs the risks.  If you are taking Suboxone, talk to your doctor about whether you should use contraception.

Side effects rarely mean that you should stop taking Suboxone.  However, contact your doctor immediately if:

You feel faint, dizzy or confused
Your breathing becomes slower than normal
You experience an allergic reaction (hives, swelling, wheezing or shock)
Your skin or white parts of your eyes turn yellow (jaundice)
Your urine turns dark
Your bowel movements turn light in color
You lose your appetite for several days
You feel sick to your stomach or have lower stomach pain
You have any other unusual symptoms.

Always keep Suboxone out of the reach of children.  For more information, visit suboxone.com.  See the package insert for more information about other safety considerations and potential drug


Comments
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Avatar universal
by Zeuss, Jul 29, 2008
Worried878
Wonderful post on information of Suboxone. It is very nice to have someone as yourself helping others by putting up information like this. It gives us people who want to do it on thier own, pertinent information on the proper use. Thank you so much for helping everyone.                       Zeuss

Avatar universal
by Drmac6380, Jan 03, 2015
I am taking 8mg of buprenorphine 8mg tab form in place of my 10mg Oxycodone up to 6 times per day and rarely take the full dose. I am a recovering alcoholic and follow a 12-step program. I have chronic pancreatitis pain 2-3/10 scale pain. For the first time since being on opioids for the last 4 years, this medication has given me hope. I do have a dependence at this time and would withdrawal if taken off of the opiates. I suffered a brain infection and staph infection over the past few months and was home bound via my doc. I ended up having a release after 7 years of sobriety. I'm not happy with my providers and his/her lack of compassion and care in the above. I am happy with the change. I do not want to be psychologically dependent as well, thus, the change of pain medication asked for by me. I am a doctoral level clinical psychology provider.this has nothing to do with addiction, my job, but more of how desperate we need providers to work with those in chronic pain before psychological dependence becomes an issue, but many of my patients with an addiction history face huge road blocks in receiving the necessary treatment, give up, and become both psychologically and physically dependent on pain meds. I'm just another person who has experienced a reluctantcy to provide services or just written off as someone they won't or cannot help. It wasn't until I put myself in a to program and not for lack of trying, but no one wants to take or it seems no one wants to take someone with a wound vacuum, but I didn't stop trying, kept drinking, and now finally back amongst the "sane" people whomever that might be.

Okay, my question? Am I just taking another pain killer? Is it the same as Suboxone minus the neloxone? Also, my insurance company is in the process of reviewing my request. They have been giving me 3 pills for 3 days until a decision comes out regarding my current dose. In addition, bc I can get acute pancreatitis, which it know no one who does not use an opiate while hospitalized and a few days after, which is how I've been taking the Oxycodone, but this episode and other infections after surgery have caused an increase in chronic pain. Ugh.

I am interested in knowing of any research studies for treatment of chronic pain with the use of sub, burp endorphins, na leone with to without this ingredient?

I am grateful for these meds, but I also am interested in research studies that use the brupenorphine with or without the nelexone.

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