Opioid Addiction

What Are the Two Different Drugs in Suboxone?

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Suboxone comprises two medications: Buprenorphine, a partial opioid agonist, and Subutex, an opioid antagonist. Buprenorphine is akin to a milder form of an opioid, with its effects being restricted. It does not provide the same pain relief or pleasure rush as a full-strength opioid. However, it can reduce the desire to consume a full opioid, as it satisfies cravings and alleviates withdrawal symptoms.

Even if higher doses of buprenorphine are taken, it is limited to how much it can suppress the brain's pain signals or activate endorphins. The likelihood of overdosing on buprenorphine is lower than that of opioids.

subutex, on the other hand, is an opioid antagonist that has opposing effects to opioids. It is commonly used to treat opioid overdoses by reversing them. Subutex is not well absorbed orally, and when combined with buprenorphine, the risks of misuse or injection (which could result in unpleasant withdrawal symptoms) are reduced.

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How Is Suboxone Given?

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Suboxone is available in two forms, namely tablet and small, thin pieces of film, designed to dissolve in the mouth and function similarly. The oral dissolving feature of Suboxone makes it a convenient option for individuals undergoing addiction recovery. The tablet or film is placed under the tongue, where it dissolves on its own, or alternatively, it can be placed inside the cheek. Suboxone is available in various dosages or strengths, with the initial dose typically being 8 mg of buprenorphine and 2 mg of Subutex, as prescribed by a physician based on the individual's recovery needs. The dosage is gradually adjusted or tapered over time by the physician, and it is strongly advised not to attempt to taper the dosage independently.

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How to Properly Administer Suboxone?

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Suboxone is intended to be administered by melting it under the tongue or inside the cheek. If you are uncertain about the proper method of administration, it is recommended that you consult with your physician or pharmacist for guidance.

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For those taking the tablet form:

Place the tablet beneath the tongue and allow it to dissolve.
Do not swallow the tablet with water.
Refrain from consuming food or beverages until the tablet has completely dissolved.
If your prescribed dose consists of more than one tablet, place the tablets in different locations beneath the tongue simultaneously.

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For those taking the film form:

Drinking a small amount of water to moisten the mouth prior to administration is permissible.
During the initial days of treatment, place the film beneath the tongue rather than inside the cheek.
Position the film beneath the tongue near the base.
Do not move the film until it has fully dissolved.
Do not chew, swallow, or cut the film into pieces.
If your prescribed dose consists of two pieces of film, place the first film on one side beneath the base of the tongue and allow it to dissolve completely. Then, place the second film on the opposite side. If a third film is required, place it on the same side as the first film. After several days, you may place the films on the cheek or the tongue.

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What is the Benefit of Combined Buprenorphine/suboxone Over Other Medications for Medication-Assisted Treatment?

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Since the early 2000s, Suboxone has been utilized as a component of medication-assisted treatment (MAT) for individuals with opioid use disorder. Prior to Suboxone, methadone was the medication of choice for MAT. Methadone remains an effective medication for opioid use disorder but is only available through registered opioid treatment programs. In contrast, Suboxone can be prescribed by a licensed practitioner.

Methadone is a long-acting, synthetic full opioid drug that helps alleviate withdrawal symptoms, reduce cravings, and diminish the euphoria of other shorter-acting opioids.

Suboxone, which combines buprenorphine and Subutex, is another medication used for MAT. Buprenorphine is a partial opioid agonist that helps reduce cravings and withdrawal symptoms, while Subutex is an opioid antagonist that helps prevent misuse of the medication.

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What Are the Possible Side Effects of Suboxone?

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Although Suboxone is generally well-tolerated, it may cause specific side effects, such as constipation, diarrhea, headaches, and nausea. Additionally, individuals may become overly reliant on Suboxone for relaxation.

Respiratory depression is a severe side effect that may occur with Suboxone use. This condition is characterized by shallow, slowed breathing that can lead to decreased oxygen levels in the blood. If an individual experiences symptoms of respiratory depression, such as dizziness, labored breathing, extreme sleepiness, or unresponsiveness, emergency medical care should be sought immediately.

While respiratory depression is rare when Suboxone is taken at the prescribed dose, it is more likely to occur when the medication is injected or taken in conjunction with alcohol or benzodiazepines (sedatives used for sleep or anxiety relief).

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Suboxone may also cause these side effects in some people:

• Back pain

• Blurred vision

• Dizziness

• Drowsiness

• Irregular heartbeat

• Insomnia (trouble falling or staying asleep)

• Loss of concentration

• Sweating

• Tongue pain

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Individuals who consume Suboxone may experience psychological side effects such as anxiety, depression, or nervousness. It is advisable to inform your physician if you observe any of these mood alterations. These changes may increase the likelihood of relapse into opioid use as a means of mitigating these emotions.

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What are the Considerations for Taking Suboxone?

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It is imperative to utilize Suboxone solely as a Medication-Assisted Treatment (MAT) component for opioid addiction recovery. It should not be taken for pain relief.

The decision to commence Suboxone as part of your recovery will be made by your physician, taking into account your safety and well-being. If you begin taking it too soon after discontinuing opioid use, you may experience severe withdrawal symptoms such as tremors, perspiration, nausea, vomiting, diarrhea, body aches, or mood swings.

Here are some other essential precautions to observe when taking Suboxone:

Do not discontinue taking Suboxone alone for any reason, even if you feel better and believe you no longer crave opioids. Abruptly stopping Suboxone will result in withdrawal symptoms.
Make an effort not to miss your regular dose of Suboxone. If you skip or miss doses for any reason, you are at risk of relapsing and desiring to use opioids. Request that your spouse, family, or friends remind you to take your dose. Store your pills or film in a container with a slot for each day's dose of your medication. You can also set reminders on your phone or write them on your calendar.
If you miss a dose of Suboxone, take it as soon as you remember unless it is close to your next dose. Do not double your next dose if you miss a dose.
Do not operate heavy machinery or equipment while taking Suboxone until you are aware of how much it affects you.
Do not take someone else's Suboxone to alleviate or treat pain. If you have never used opioids as a pain reliever, using Suboxone to treat pain alone can result in death, even at low doses.
Never misuse, overuse, or inject Suboxone. This can cause withdrawal symptoms, respiratory depression, or death.

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The 3 Stages of Suboxone Treatment:

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The Induction Phase is the initial stage of Suboxone treatment. Prior to taking Suboxone for the first time, it is imperative that the patient has no opiates in their system and is experiencing moderate opiate withdrawal. Failure to wait until opiate withdrawal before taking Suboxone may result in precipitated withdrawal, a sudden and extreme withdrawal. The time that one must wait after last using opiate drugs before beginning treatment with Suboxone depends on the half-life of the previously used drug. Short-acting opiates such as heroin or OxyContin require a waiting period of 12 to 24 hours following the last use before initiating treatment with Suboxone. Conversely, long-acting opiates such as methadone require a longer waiting period before initiating Suboxone treatment.

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Once in a state of withdrawal, the patient will take their first dosage of Suboxone or Subutex under observation in a doctor’s office. If there are no adverse reactions and the patient responds well to the treatment, the dosage will be adjusted until there are no further opiate withdrawal symptoms or drug cravings. The induction phase typically lasts about a week, with the goal of finding a Suboxone dosage that provides the best relief from withdrawal symptoms and drug cravings.

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The Stabilization Phase commences once the patient no longer experiences any opiate withdrawal symptoms due to their use of Suboxone and is no longer abusing opiates. This phase lasts until the patient feels very stable and robust on Suboxone and is able to resist the abuse of opiates. The stabilization phase typically lasts between 1 and 2 months.

Patients doing well on a steady dose of Suboxone enter the Maintenance Phase of treatment.

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Maintenance Phase of treatment, there is no set duration for this stage of treatment, and some patients may choose to remain in the maintenance stage with Suboxone indefinitely.

Treatment with Suboxone is concluded by tapering down the dosage until complete cessation of use is achieved. Suboxone tapering begins either at the end of the stabilization phase or the end of the maintenance phase.