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How Does Suboxone Work
December 14, 2018

How Does Suboxone Work

The opiate epidemic has cut a wide swath of personal and societal destruction across America in recent years. An estimated 2.1 million people aged 12 and older had a diagnosed opioid use disorder (OUD) in 2017, according to data from the 2017 National Survey on Drug Use and Health (NSDUH). Finding appropriate, effective and safe medications for use in detox and subsequent treatment of opiate dependence and addiction has become the focus of governmental agencies, including the National Institute on Drug Abuse (NIDA), involving increased funding, advancing clinical trials of promising drugs and broadening awareness of effective drug rehab treatment. In 2002, the Food and Drug Administration (FDA) approved a prescription mediation buprenorphine (brand names, Suboxone and Subutex) for the treatment of opiate addiction.

WHAT IS SUBOXONE?

Suboxone is the brand name of a prescription medication used to help alleviate withdrawal symptoms of opiate dependence or addiction. Suboxone contains buprenorphine, a partial opioid agonist, and naloxone, an opioid antagonist.

Suboxone is a partial agonist opiate medication, which means the buprenorphine occupies a person’s opiate receptors in their brain, yet it does not cause the acute effects of narcotics. The naloxone, an opioid antagonist, works to reduce or diminish opiate cravings and withdrawal symptoms.

HOW IS SUBOXONE USED IN MEDICATION-ASSISTED TREATMENT?

Medication-assisted treatment (MAT) is considered the gold standard and the front line of defense in both detox from opiates (including prescription opiates) and in formal treatment following detox. The first determinant for a treatment plan depends on what kind of opiate the individual was taking. The doctor may first start the person on a low buprenorphine dose and then increase the dosage for a day or two before transitioning to a medication with buprenorphine and naloxone. Again, depending on opiates taken, another option the doctor may choose is buprenorphine and naloxone treatment right away.

HOW DOES SUBOXONE WORK?

Because suboxone is an opiate, albeit one that doesn’t produce too much of a euphoric feeling at low doses, it does give the user a mild “buzz” or “high.” If, however, the individual takes too much suboxone, or increases the doses, there is no resulting increase in the high. Rather, it just levels off. Anecdotal evidence is that individuals say they don’t feel particularly well after taking higher doses of suboxone.

Suboxone tightly binds to receptors in the brain, and does so more than other narcotics. Someone taking suboxone while under the influence of or already taking other narcotics – such as methadone, hydrocodone, or Oxycontin — can go into immediate severe withdrawal. Suboxone actually knocks those narcotics off the receptor and plunges the user into abrupt withdrawal. That’s why the recommendation is that the individual must be in withdrawal already before his or her treating physician or clinician can start them on suboxone.

This does not mean the individual has to be in severe withdrawal before suboxone can be initiated. In other words, you don’t need to be experiencing severe diarrhea and cramping or other signs of severe withdrawal. As long as you’re showing signs or symptoms of mild withdrawal, including some cravings, treatment with suboxone can usually be started, if the treating physician determines this is the best course of treatment for your particular situation.

The unique pharmacological properties in suboxone basically work in the following ways to:

  • Lower misuse potential
  • Reduce or diminish effects of physical dependence on opiates – such as symptoms of withdrawal and cravings
  • Increase safety in cases of overdose

Suboxone Side Effects

Suboxone’s side effects are similar to the side effects of opiates and may include:

  • Constipation
  • Cramping
  • Cravings
  • Distress
  • Fever
  • Muscle aches and cramps
  • Nausea
  • Sleep problems
  • Vomiting

Do not take other sedatives, particularly benzodiazepines, while taking suboxone. Doing so will produce an additive effect of sedatives, which may prove dangerous, even deadly. Grinding suboxone and mixing with benzodiazepines to create an injectable solution has caused deaths. Other precautions include avoiding use of tranquilizers, antidepressants, or sedatives – unless directed by a doctor, and avoiding alcohol.

How is Suboxone taken?

According to MedLine Plus, the medication suboxone is a sublingual tablet placed under the tongue (sublingual application). There is also a buccal film (Bunavail) that is applied between the cheek and gum. Buprenorphine alone comes as a sublingual tablet (Subutex). The treating doctor first determines the appropriate dose, and the individual in treatment then usually takes the prescribed dose once a day. The medication should be taken at the same time each day to help the individual stay in compliance with the medication regimen.

Taking the medication exactly as prescribed is important. Sublingual tablets need to be placed beneath the tongue until the medication is completely dissolved. If more than one sublingual tablet is prescribed, both should be placed under the tongue at the same time. The medication includes the warning not to chew or swallow the tablets whole. In addition, refrain from eating or drinking any liquids until the tablets have completely dissolved.

Taken at the right doses, suboxone minimizes symptoms of withdrawal, reduces cravings, and partially blocks the effects of other opiates. With daily suboxone maintenance doses, during the prescribed short-term treatment, the medication keeps the opiate receptors in the brain occupied and remains on the receptors for several days. Thus, other opiates have great difficulty attaching to the receptors.

How Long Does Suboxone Stay in Your System?

While you are taking suboxone as prescribed by your treatment professionals, either during detox or subsequently during short-term suboxone treatment, you may be curious about how long the medication stays in your system.

Suboxone has a relatively long half-life of 36 to 72 hours. Yet, how long it stays in your system depends on factors that include dosage, usage, metabolism and body fat. According to testing experts, the medication will be undetectable in urine after 2 to 4 days of abstinence. Suboxone shows up in blood testing for the drug about 2-1/2 weeks (17 days), or longer. Hair tests for the presence of suboxone have a longer detection time of around 90 days.

Suboxone Misuse Potential

Suboxone can be misused as a result of its opiate effects. This is particularly true among those who are not dependent on opiates. The naloxone that’s added to buprenorphine helps prevent diversion and misuse of the combination drug product. When suboxone is taken as sublingual tablets, the buprenorphine content dominates the opiate effects, while the naloxone content blocks opiate withdrawal. However, crushing and subsequently injecting sublingual tablets precipitates the naloxone domination effect and can bring on opiate withdrawal.

HOW EFFECTIVE IS SUBOXONE?

Effectiveness of medications or treatments used in drug rehab, particularly with opiate rehab, may be measured by their ability to reduce frequency and severity of withdrawal symptoms, whether they’re successful in reducing cravings, how they affect the duration of treatment, and the likelihood that the individual will go on to complete treatment.

A 2008 clinical trial of suboxone administered for an extended time (12 weeks) to young adults with opiate addiction, conducted by the National Drug Abuse Treatment Clinical Trials Network and supported by the NIDA, found substantially better treatment outcomes than those receiving standard treatment of short-term detox using suboxone and counseling. Researchers found that the opiate-addicted youths who stayed in the 12-week suboxone treatment were less likely to use opiates, marijuana and cocaine, to inject drugs or quit treatment than youths only receiving short-term detox and counseling. The youths had been addicted to opiates – including heroin, morphine and prescription painkillers such as Oxycontin and Vicodin — an average of 1.5 years.

A 2017 study of controlled clinical trials of interventions using buprenorphine (or methadone, clonidine or lofexidine) to modify opiate withdrawal signs and symptoms in opiate-dependent individuals found that buprenorphine was associated with less severe withdrawal symptoms (compared to use of clonidine or lofexidine), individuals stayed in treatment longer, and were more likely to complete withdrawal treatment. Authors concluded that buprenorphine is more effective than either clonidine or lofexidine in managing the severity of opiate withdrawal, duration of withdrawal treatment and treatment completion. They suggested further that it is possible that opiate withdrawal symptoms may differ, and the symptoms of withdrawal may be more quickly resolved with buprenorphine. Multiple factors could be involved in the individual’s response to dose taper with buprenorphine or methadone – such as whether or not the initial treatment plan called for subsequent relapse prevention treatment with naltrexone.

A 2018 study in Lancet analyzed the effectiveness of sublingual buprenorphine-naloxone (BUP-NX), a partial opioid agonist, versus extended-release naltrexone (XR-NXT), an opioid antagonist, in preventing opiate relapse in individuals diagnosed with opioid use disorder (OUD). Researchers found that it was more difficult to initiate XR-NXT than BUP-NX, but that once initiated, both treatments were safe and effective. BUP-NX showed better results in opioid-negative urine tests and more opioid-abstinent days than XR-NXT, yet XR-NXT demonstrated better ability to reduce initial opioid cravings, but both treatments were similar in craving reductions at 24 weeks.

The most important point to remember about how suboxone works is that your treating physician or drug rehab treatment team will determine the best MAT to address your opiate addiction and particular circumstances. You should trust their professional judgment and expertise in this area and recognize that your treatment plan will be adjusted and modified to meet changing needs. This includes transitioning from one form of suboxone to another, or a different MAT, as well as incorporating behavioral counseling and other therapies as part of a comprehensive treatment plan to overcome opiate dependence and addiction.

For more about exercise, addiction and recovery, check out these articles:

Dangers of Long-Term Suboxone Treatment

Suboxone Detox – Withdrawal Symptoms and Timeline

Will Suboxone Show up in a Drug Test?  

Prescription Opiate Detox: What to Expect from Withdrawal and Recovery

Addiction Recovery Tips: Key Components of a Healthy Recovery Lifestyle

Why Medication-Assisted Treatment is Important for Opiate Addicts in Early Treatment

Sources:

Canadian Family Physician. “Primary care management of opioid use disorders: Abstinence, methadone or buprenorphine-naloxone?” Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/28292795

Cochrane Database of Systematic Reviews. “Buprenorphine for managing opioid withdrawal.” Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/28220474

Cochrane Database of Systematic Reviews. “Opioid agonist treatment for pharmaceutical opioid dependent people.” Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/28447766

Cochrane Database of Systematic Reviews. “Supervised dosing with a long-acting opioid medication in the management of opioid dependence.” Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/28447766

Contemporary Clinical Trials. “NIDA Clinical Trials Network CTN-0051, Extended-Release Naltrexone vs. Buprenorphine for Opioid Treatment (X:BOT): Study design and rationale.” Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/27521809

Drugs.com. “Suboxone.” Retrieved from https://www.drugs.com/pro/suboxone.html

Lancet. “Comparative effectiveness of extended-release naltrexone versus buprenorphine-naloxone for opioid relapse prevention (X:BOT): a multicentre, open-label, randomised controlled trial.” Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/29150198

MedlinePlus. “Buprenorphine Sublingual and Buccal (opioid dependence).” Retrieved from https://medlineplus.gov/druginfo/meds/a605002.html

National Institute on Drug Abuse. “Buprenorphine.” Retrieved from https://archives.drugabuse.gov/buprenorphine

National Institutes of Health. “Extended Suboxone Treatment Substantially Improves Outcomes for Opioid-Addicted Young Adults.” Retrieved from https://www.nih.gov/news-events/news-releases/extended-suboxone-treatment-substantially-improves-outcomes-opioid-addicted-young-adults

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