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Article Summary

A Guide To Suboxone Treatment And Addiction

Otherwise sold as Suboxone or Subutex, buprenorphine was first approved by the FDA (Food and Drug Administration) for clinical use in 2002. Today, it represents the latest advancements in MAT (medication assisted treatment).

Drugs such as buprenorphine - especially when used in combination with behavioral therapies and counseling - provide a wholesome approach to the medical treatment of opioid tolerance, dependency, and addiction.

Methadone, a similar drug used to treat opioid addiction, is different from buprenorphine in the sense that it is only used in highly structured clinical setups. Buprenorphine, on the other hand, is used as the first medication of choice for such treatment. Alternatively to methadone, it can be dispensed or prescribed at a physician's office which significantly increases access to treatment.

According to DATA 2000 (the Drug Addiction Treatment Act of 2000), qualified physicians in the US can now offer this drug for opioid addiction in a variety of settings. These include in offices, correctional facilities, health departments, and community hospitals, among others. Similarly, SAMHSA-certified OTPs (opioid treatment programs) are allowed to provide buprenorphine but only as a dispensation of the drug.

As with any other drug used in MAT, buprenorphine is generally prescribed as a small part of a more comprehensive addiction treatment plan. This is because it works more effectively when the patient participates in social support programs and undergoes counseling.

This medication, in particular, comes with some benefits when used by those suffering from opioid dependency and addiction, as well as other patients for whom treatment in methadone clinics is less convenient or not preferred. Additionally, the FDA has approved the following products made from buprenorphine:

  • Bunavail buccal film (made from naloxone and buprenorphine)
  • Suboxone film (also made from naloxone and buprenorphine)
  • Zubsolv sublingual tablets (another combination of naloxone and buprenorphine)
  • Buprenorphine-containing transmucosal medications for opioid dependency

To be more specific, buprenorphine is the preferred drug of choice because it comes with specific pharmacological properties that assist in:

  • Lowering the potential for drug misuse and altercation
  • Diminishing the effects arising from physical dependency to opioid medications, including drug cravings and withdrawal symptoms
  • Increasing safety in case of an overdose

Understanding Suboxone And Subutex

Also referred to as Subutex or Suboxone, buprenorphine was marketed by Reckitt and Colman in the 80s. The company introduced this drug to the market in the form of an analgesic available in an injectable formula and sublingual tablets.

In 2002, the FDA approved its used in opiate dependency and addiction treatment. At the time, the drug was marketed as Subutex or Suboxone and is now predominantly used as a detox medication for people suffering from addiction to such opiates as OxyContin and heroin.

However, it wasn't until 2006 that the EU (European Union) approved suboxone for use in treating opiate addiction. The countries forming this Union also use buprenorphine in treating chronic pain.

At its most basic, buprenorphine is classified as an opioid partial agonist. It follows that this drug is like opioids in the sense that it produces such effects as respiratory depression and euphoria. However, these effects are milder with buprenorphine than they are with full drugs like methadone and heroin.

The opioid effects of this drug increase with every additional dose. At moderate doses, these effects start leveling off even after you increase the dose. This ceiling effect somewhat lowers the risk of abuse, misuse, side effects, and dependency. Further, since this drug contains a long-acting agent, it follows that patients are not required to use it more than once daily.

As a semi-synthetic opioid, buprenorphine (Suboxone or Subutex) is commonly used to treatment opioid addicts and deal with their withdrawal symptoms. It comes with various attributes that give it its detoxification properties.

For instance, it has a strong-binding potential. This means that it will tightly bind itself to the brain's opioid receptors. As a direct result, if there are any other opioids in your body (such as oxycodone, morphine, or heroin), the buprenorphine component of the Suboxone or Subutex will effectively block them so that they don't bind to these receptors.

To this end, using other opiates together with buprenorphine do not produce additional euphoria and discourage the addict from further use. However, buprenorphine is an opiate in it's own right and still possesses addictive qualities, especially when used regularly for any length of time, just like any other opiate.

Only those doctors with a specific license are allowed to prescribe buprenorphine. Among these, the treatment plans commonly range from a month to a year. The length of treatment mostly depends on several factors, such as frequency of use and dosage.

In many instances, the doctor may start your treatment at a high dose before titrating slowly to a lower dose until your life has stabilized and eventually no longer need the drug. Still, this is not to mean that buprenorphine does not cause withdrawal symptoms. In fact, some users testify that the withdrawal symptoms can be even worse than OxyContin and heroin when stopping cold turkey. This is why doctors will wean you off slowly over the course of several months or longer.

Subutex Versus Suboxone

To better understand buprenorphine, it is imperative that you learn more about the drugs which contain it - the most common of which include Suboxone and Subutex. Although these two drugs are quite similar, they are different in one major area. Whereas Subutex only contains buprenorphine, Suboxone is a combination of Naloxone and buprenorphine. The Naloxone component in Suboxone is an opiate antagonist. Therefore, apart from the Naloxone, both Subutex and Suboxone are same drug.

Suboxone is sold as a sublingual film (which is quite similar to the more common Listerine strip). As such, you don't get a pill to swallow. Instead, the doctor will prescribe a small film that you put directly under the tongue where it dissolves. The Naloxone component is added to prevent users from trying to inject Suboxone because naloxone, when injected, effectively blocks the effects of all opiates in the system. However, when ingested sublingually with buprenorphine, naloxone virtually has no effect.

When naloxone is injected, the user will not be able to achieve any euphoria from opiates including buprenorphine. In fact, if the person is dependant on opiates at he time of injection, he/she will quickly experience opiate withdrawal symptoms because naloxone flushes all opiates out of the opiate receptors in the brain. The inclusion of naloxone prevents the users from attempting to snort or inject Suboxone, as the naloxone will then cancel out the effects of the buprenorphine and any other opiates. Other than Naloxone, Suboxone and Subutex are virtually the same substance.

That said, doctors usually find that Suboxone comes with slightly higher success rates than Subutex although both tend to be quite effective at deterring opiate withdrawal symptoms.

Both Subutex and Suboxone are taking the lead over methadone due to their buprenorphine component, which is now the drug of preference for most doctors looking to prescribe medication to help opioid addiction.

While methadone is classified as a Schedule II controlled substance, the buprenorphine part of Suboxone and Subutex is grouped among other Schedule III controlled substances. This means that it carries a lower potential for dependence and abuse. As a direct result, this component is considered to be the safer medication for treating opiate addiction in comparison to methadone.

In 2013 the DEA (Drug Enforcement Agency) reported that close to 16000 doctors are now certified to prescribe these buprenorphine-containing products. In the same report, it was found that about 9.3 million prescriptions were issued in 2012 for these medications.

Since then, the American Journal on Addictions has reported that prescriptions of buprenorphine and other formulations containing it as a component have seen a substantial increase from 2003 to 2013.

Subutex / Suboxone Uses

As mentioned above, doctors typically prescribe buprenorphine as the stand-in medication of choice for treating opiate addiction. As you undergo detox from oxycodone, fentanyl, hydrocodone, heroin, and other opioids, your doctor may prescribe drugs like Suboxone or Subutex to help with the adverse and severe withdrawal symptoms you might be experiencing as a result of your dependency.

However, as mentioned earlier, the buprenorphine component in these two drugs are addictive in and of themselves. In some instances, some people even start abusing buprenorphine recreationally and acquire them illicitly on the streets.

Most doctors, however, hope that patients who are put on buprenorphine will only be encouraged to slowly wean their bodies from the opiates they have been abusing. This is because withdrawal is commonly a major concern for most users.

The other benefit that comes with using Suboxone and Subutex is that controlled administration empowers doctors to keep their patients from altering their use of buprenorphine - such as from injecting and the sharing of needles, which inadvertently increases the risk of even more adverse illnesses such as HIV, hepatitis, and AIDS.

That said, both are widely prescribed to eliminate or at least minimize the physical withdrawal symptoms and both effectively block the effect of other opiates in the brain.

Although the buprenorphine in these medication might not produce a high quite as powerful as that from other opiates, it still comes with the risk for abuse. In the same way some desperate addicts take large doses of cough medication to achieve a high from codeine, some people may also abuse buprenorphine-containing drugs.

Due to this potential, naloxone is combined with buprenorphine to form Suboxone. Such mixing keeps users from the risk of abusing the buprenorphine component. The naloxone works as an opiate antagonist in the sense that it will fill the brain's opiate receptors without necessarily activating them.

On the other hand, Subutex might be more addictive in the sense that it contains 100% buprenorphine. As such, it can be snorted or injected. It is on this account that most doctors prefer to prescribe Suboxone because it has a decreased risk of diversion and abuse and is deemed safer for patients to take home and continue using.

That withstanding, buprenorphine comes with a number of benefits when it is applied for the treatment of opiate misuse, abuse, tolerance, and dependence. These benefits include, but are not limited to:

  • It may help users remain comfortable and safe as they undergo opiate detox
  • It sometimes eliminates or reduces the cravings users may have for such opiates as heroin
  • It minimizes the risk for a relapse because patents may not experience uncomfortable withdrawal symptoms if they are put on buprenorphine
  • It allows patients the freedom and ability to focus on their therapy without the distraction that cravings and withdrawal symptoms are likely to cause

Subutex / Suboxone Effects

Those who use buprenorphine-containing drugs like Subutex and Suboxone often find that the medications produce euphoria and a high that is quite similar to that derived from commonly-abused opiates and opioids. If you have already taken these drugs or you are tolerant to opiates, you are likely to experience less gratifying effects.

Regardless of your experience with using buprenorphine recreationally, this drug may help you detox from opioid and opiate addiction with less discomfort. It works by attaching itself to the brain's opiate receptors in the same way that normal working mechanism of most opiates. As such, buprenorphine can be effective for those looking to wean off other opiates while undergoing rehabilitation for drug addiction.

In the short term, however, abusing buprenorphine-containing drugs tends to elicit some of the characteristic effects you might desire. Since it is a partial opioid agonist, this drug produces a high that is similar to other opioids - but with a milder sedation. It also lacks in the profound cognitive impairment commonly associated with powerful prescription opioids and heroin.

These short term effects arising from buprenorphine use include:

  • Decreased pain
  • Euphoria
  • Sedation

Subutex / Suboxone Side Effects

In the same way, using buprenorphine-containing medications like Subutex and Suboxone is likely to lead to the following side effects:

  • Constipation
  • Dizziness
  • Drowsiness
  • Dry mouth
  • Addiction
  • Headaches
  • Lightheadedness
  • Mood swings
  • Nausea
  • Sweating
  • Vomiting

If you experience serious side effects, you might want to talk to your primary healthcare provider immediately. These side effects are dangerous in the sense that they might signal the onset of significant liver damage. They include, but are not limited to:

  • Yellow skin
  • Dark urine
  • Yellowing in the eye whites
  • Severe stomach pain.
  • Lightly-colored bowel movements

At some point, you might find it desirable (or even necessary) to stop using buprenorphine. This is because the side effects from these medications may prove to be too intolerable and uncomfortable.

For instance, you may find yourself in a physical condition that would require that you stop using the drugs temporarily - such as when you need to undergo surgery, when you are nursing, or if you contract a pregnancy.

It is also quite possible for some users to develop allergic reactions (as well as other dangerous reactions) to buprenorphine. In these cases, using the drug may result in hives, itching, trouble breathing, and other similar problems. Needless to say, see your doctor immediately you start experiencing these reactions.

Based on the official information on buprenorphine (and its constituent drugs), you may desire or need to stop taking the prescription if you:

  • Show signs of an allergic or dangerous reaction to the drug
  • Have trouble breathing
  • Exhibit signs of an overdose
  • Have surgery
  • Are nursing or pregnant
  • Experience side effects that you find too difficult to bear or manage
  • Show signs of continued substance abuse or addiction

Additionally, if you display behavioral or lifestyle changes that indicate you might be able to maintain recovery in the long term without buprenorphine, your doctor may taper the drug or discontinue it altogether. In these situations, they may put other measures and therapeutic interventions in place to support your continued abstinence from drug abuse.

Most of these behavioral changes may be achieved through therapy programs, medically supported addiction treatments, and residential rehabilitation - among many others.

Subutex / Suboxone Addictive Qualities

One of the latest drugs to be introduced for the treatment of opiate addiction, buprenorphine is currently the only medication approved for use solely in drug addiction treatment (with no other direct medical purpose).

However, many people are increasingly concerned about its potential for addiction. Luckily, this was a concern that doctors considered even as the drug was undergoing development.

To be more specific, buprenorphine and its constituent drugs was designed in such a way that its potential for abuse is lessened - especially in comparison to other opiates, both illegal and prescription medications. Some of the measures put in place to ensure this included:

  1. Naloxone

    Naloxone is combined with buprenorphine to form Suboxone. In most cases, Naloxone remains inactive unless the user ingests it intravenously. This protection drug, therefore, binds to the brain's opiate receptors to stop and block the effects of opiates. As a direct result, addicts are deterred from abusing it.

  2. Doctor Training

    In the same way, those doctors who are certified to prescribe medications containing buprenorphine undertake a training course on this drug. Increasing education and decreasing accessibility means that those who receive the medication have a higher likelihood of understanding how they should use their prescription.

  3. Prescription Limits

    The number of patients who are allowed to receive buprenorphine-containing drugs as a prescription is severely limited. Doctors are only allowed to write a specific number of prescriptions in a given time period.

  4. Ceiling Effect

    Last but not least, buprenorphine is uniquely formulated. This is in the sense that after a given dosage, its effects will not increase. This effectively limits the potential that it can get people high while also reducing the chances that it might cause an overdose.

However, you can still develop an addiction to the drug - especially if you use it recreationally or without a valid prescription. In such a situation, the best solution would be to seek out medical attention and treatment.

This is because buprenorphine is quite like any other opioids that it attempts to replace in the sense that it can cause dependency. Of course, if you used it according to a prescription, your doctor is mandated to try and monitor your dosages and consumption. However just because it is doctor prescribed does not reduce it's potential for addiction.

However, the nature of this medication is such that your body may require more of it to achieve the same effects. Such addiction may eventually lead to withdrawal symptoms if you try quitting using buprenorphine-containing drugs.

Over time, you might increase your dosage or prolong your use. This happens after you become dependent on it and your body builds tolerance to medications with buprenorphine as an active ingredient.

Tolerance often causes you to start taking more of the drugs for the simple purpose of feeling and experiencing the effects of buprenorphine. In such a situation, your dependency may make you feel ill if you attempt to stop using the drug with no medical assistance.

Subutex / Suboxone Overdose

Unlike the opiates it is designed to deal with, buprenorphine tends to be less dangerous. However, overdose may occur - in most cases - unintentionally. As with any drug, you could combine the buprenorphine-containing drug with another substance.

These substances may be ones that counteract each other or that serve similar purposes in the human body. Once they get into the system, the drug combination may prove to be lethal. Due to this factor, even a lose dose may lead to accidental death.

However, taking sedatives such as alcohol together with Suboxone or Subutex often intensifies the effects of an overdose. This also happens when you increase your dosage of these drugs.

On the other hand, if you are using buprenorphine to deal with an opiate addiction, risk of overdose is decreased. This may be because your body is already used to having opiates in the system.

However, once you overdose on buprenorphine, the symptoms might be difficult to reverse. The most dangerous of these irreversible symptoms is respiratory depression when you will only be able to take short and shallow breaths. As a result, the amount of carbon dioxide in your blood will increase, leading to fatal consequences.

The other signs and symptoms of buprenorphine (Suboxone and Subutex) overdose may include:

  • Cold and clammy skin
  • Coma
  • Extreme weakness
  • Fainting
  • Hypotension
  • Sedation
  • Slowed breathing

On the other hand, your risk of suffering adverse health effects from an overdose increases when you take buprenorphine in combination with other depressants, sedatives, and tranquilizers. In such situations, you could experience the following symptoms:

  • Convulsions
  • Dark urine
  • Increased or unusual sweating
  • Low blood pressure
  • Nausea
  • Seizures
  • Severe confusion
  • Severe dizziness
  • Severe drowsiness
  • Severe nervousness
  • Slow heartbeat
  • Stomach cramps or pain
  • Vomiting
  • Yellowing skin or eyes

If you experience any of the symptoms of an overdose, you need to seek immediate medical attention. This is because some of these signs and symptoms may prove to be fatal.

Subutex / Suboxone Withdrawal

Once you become tolerant to buprenorphine, your body may develop dependency to the drugs containing this active ingredient. In such situations, if you try to stop using these substances, you are likely to experience the following withdrawal symptoms:

  • Anxiety
  • Chills
  • Craving for the drugs
  • Depression
  • Diarrhea
  • Dilated pupils
  • Goose bumps
  • Increased pain
  • Insomnia
  • Loss of appetite
  • Muscle aches
  • Nausea
  • Restlessness
  • Secretion of tears
  • Sweating
  • Tremors
  • Vomiting
  • Yawning

Subutex / Suboxone Dangers

Due to the opioid effects of buprenorphine, the drug may be misused especially by those who do not get a prescription for it. Such misuse might lead to an exacerbation of pre-existing conditions, including liver disease and asthma (or reactive airway disease).

Even if you have a prescription, you may still experience certain drug interactions. These interactions may increase your risk of suffering life-threatening cardiovascular collapse or respiratory depression.

Those who stop taking buprenorphine-containing drugs in favor of abusing opiates may find that their bodies have become hypersensitive to opiate effects. This may increase the risk of an overdose and sudden death.

Finally, if you choose to inject buprenorphine instead of taking it as the doctor prescribed, you increase your risk of suffering blood-borne diseases (such as HIV and Hepatitis), abscesses, as well as other complications commonly associated with intravenous drug use.

Signs And Symptoms Of Suboxone / Subutex Abuse

Like with any other addiction, abusing such buprenorphine-containing drugs as Suboxone and Subutex causes a number of signs and symptoms. These might not always be easy to observe in patients. However, you should still watch out for the following:

1. Physical Symptoms
  • Changes in your sleep patterns
  • Flu-like symptoms
  • Constricted(small) pupils
  • Itchy skin
  • Sleepiness
  • Signs of intravenous use, such as skin bruising
  • Yellowing of eyes or skin
2. Behavioral Symptoms
  • Buying Buprenorphine illegally or on the street
  • Changing your circle of acquaintances and friends
  • Doctor shopping to get more than one prescription for these drugs
  • Falsifying prescriptions so as to acquire the drug
  • Have money difficulties due to continued drug abuse
  • Intense cravings for buprenorphine
  • Lack of control with regards to your use of the drugs
  • Losing interest in sex
  • Mental preoccupation with looking for, acquiring, and using the drugs
  • Neglecting your hobbies and those activities you once used to enjoy
  • Persistent failure to meet your responsibilities and obligations at home, work, or school
  • Taking buprenorphine-medications that were not prescribed for you
  • Taking Suboxone or Subutex for reasons other than they are intended for
  • Taking the drugs in larger doses or more often than you intended
  • Trading, selling, or buying to acquire more of the drugs
  • Using Subutex/Suboxone for a prolonged time period, even after observing its negative consequences in your life and health

Treatment For Suboxone Addiction

In case you get addicted to buprenorphine-containing drugs such as Suboxone and Subutex, you may need to undergo outpatient or inpatient rehabilitation to treat your abuse, tolerance, and dependency on the drugs.

Inpatient rehabilitation commonly works best because you will receive the one-on-one certified attention you require to effectively overcome the physical dependency your body has developed to buprenorphine. This type of treatment is also quite effective because it available opportunities to explore any deep emotional issues that may have led to the substance abuse.

However, before you enroll for either inpatient or outpatient rehab, it might be necessary for you to undergo detoxification. The detox may be designed in such a way that your body will be purged of all buprenorphine until you no longer require the drug to continue functioning optimally.

Overall, holistic addiction treatment tends to work wonders for those who find themselves having developed tolerance and dependency to buprenorphine-containing medications. The earlier you get started, the easier it will be to recover and to get your life back on track.

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