What is Suboxone?
Suboxone is the trade name for a medication that contains buprenorphine and naloxone and is approved for the treatment of opioid dependence. Opioid dependence is an addiction to any form of narcotic such as heroin, oxycodone, hydrocodone, morphine and fentanyl.
It reduces narcotic withdrawal symptoms such as abdominal cramps, diarrhea, muscle cramps, vomiting, cold sweats, aches, agitation, anxiety, insomnia and nightmares. Buprenorphine eliminates “cravings” for narcotics in opiate addicts when used as prescribed. Suboxone is the first opioid approved for use in an outpatient setting.
Buprenorphine: mechanism of action
Unlike oxycodone, methadone and hydrocodone which are all “agonists,” however, the active ingredient in Suboxone, buprenorphine, is a partial agonist. With agonists, the more drug that is used, the greater the achieved effect, but, buprenorphine, as a partial agonist, will relieve pain only up to a certain point at which there is a “ceiling effect.” Any increase in its dose beyond that point will have no additional effect.
The buprenorphine attaches to empty opioid receptors in the brain. While the buprenorphine is attached to the opioid receptors, patients are unable to feel the rush and euphoria from opioids such as heroin, vicodin, or oxycontin. This is because the buprenorphine blocks all other opiates from binding to these opiate receptors.
Naloxone: mechanism of action
Naloxone is an opioid antagonist that is inactive when taken sublingually, orally or inhaled but causes severe narcotic withdrawal when injected. Thus, naloxone guards against the misuse of buprenorphine tablets. When attempts are made to crush and dissolve the buprenorphine tablets for intravenous use, the naloxone produces marked narcotic withdrawal.
Suboxone is supplied as an orange tablet containing Buprenorphine and Naloxone in a 4:1 ratio, and is used for detoxification or maintenance treatment of opiate addiction. Suboxone is placed below the tongue and allowed to dissolve for a period of 5 to 10 minutes. If taken once daily, it blocks the effects of any other narcotics that the addict may choose to take.
If Suboxone has been taken regularly for a long time, sudden discontinuation may cause severe withdrawal reactions (e.g., muscle aches, runny nose, watery eyes, agitation). The withdrawal syndrome is typically milder than seen with full agonists and may be delayed in onset.
Suboxone can cause breathing problems especially when taken with other respiratory depressants. Potentially fatal reactions can occur when Suboxone is combined with benzodiazepines, sleeping pills, alcohol or antidepressants.
How Suboxone works
Suboxone treatment is typically started with the patient in mild withdrawal. The starting dose is administered in a specially licensed physician’s office. The maintenance level is determined by a lack of withdrawal symptoms and the patient’s ability to function normally. A typical maintenance dose ranges from 12 mg to 16mg. The patient can be tapered off the Suboxone at any time. The withdrawal period can last anywhere from two to four weeks but may take longer.
Compared to methadone
Methadone requires a visit to a medical clinic on a daily basis. It can be used together with other opiates which can cause a fatal overdose. The potential for abuse and overdose is significantly less with Suboxone than with methadone.