- Addiction & recovery
How to Get On Suboxone?
David Schwartz, MD
December 6, 2021
In light of the growing opioid crisis, the U.S. Food and Drug Administration (FDA) approved three medications for opioid use disorders (MOUD), namely methadone, naltrexone, and buprenorphine. Suboxone is a formulation of buprenorphine that the FDA most recently approved to treat opioid addiction. According to the American Society of Addiction Medicine (ASAM), Suboxone is one of the most recommended medications to treat opioid dependence.
Suboxone contains a combination of buprenorphine and naloxone and is available as oral tablets, sublingual film strips, and buccal film strips. Suboxone is a Schedule III controlled medication that can be prescribed and dispensed by healthcare practitioners who have received special training and certification from the U.S. federal government.
The Role of Buprenorphine and Naloxone in Suboxone
According to the Substance Abuse and Mental Health Services Administration (SAMHSA), buprenorphine is a partial opioid medication that works by binding to opioid receptors in the brain. The buprenorphine in Suboxone helps minimize opioid cravings and withdrawal symptoms associated with opioid addiction without generating intoxicating effects. The “ceiling effect” of buprenorphine also helps reduce the risk of an overdose.
According to the National Institute on Drug Abuse (NIDA), naloxone is an opioid antagonist (inhibitor) that works by blocking the effects of other opioids and reducing the risk of misuse. Both ingredients work together to help reduce the risk of relapse and prolong recovery.
How to Get On Suboxone?
It’s important to seek the guidance of a Suboxone doctor or any other primary care provider authorized to prescribe Suboxone before starting treatment. The healthcare provider will first assess a person’s condition to determine their eligibility for Suboxone maintenance treatment (SMT). Once deemed eligible for treatment, the healthcare practitioner will construct an individualized treatment plan that meets the requirements and conditions of each person. However, in light of the recent Covid-19 outbreak, the DEA has permitted practitioners to prescribe suboxone via telemedicine without conducting the initial in-person evaluation.
Suboxone Treatment Stages
Suboxone is generally prescribed during the onset of acute opioid withdrawal symptoms. Taking it before this period can trigger precipitated withdrawals, which is a sudden onset of intense withdrawal symptoms.
Suboxone is generally taken across three phases of treatment, namely:
- Induction – The right dose of Suboxone for each individual is determined and adjusted during the induction phase of treatment. During this phase, Suboxone is prescribed to help minimize the symptoms of opioid withdrawal and cravings.
- Stabilization – Once a person no longer experiences the symptoms of opioid withdrawal, they are considered to have entered the stabilization phase. Suboxone during the stabilization phase is maintained at a steady dose to keep opioid cravings in check while the individual in recovery goes through other elements of their treatment program.
- Maintenance – People who are doing well on a steady dose of Suboxone are considered to have entered the maintenance phase. The maintenance phase of treatment can last anywhere between months, years, or indefinitely, depending on individual treatment needs. Individuals who wish to stop using Suboxone are gradually tapered off the medication towards the end of their treatment program.
It’s important to note that Suboxone alone is not a cure for opioid use disorder (OUD). It’s merely a component in a rather comprehensive treatment regimen that includes counseling, behavioral therapies, and aftercare support.
Who Should Avoid Suboxone Treatment?
Although Suboxone is proven to be an effective means to maintain long-term sobriety from opioids, it may not be the ideal treatment choice for everyone. Hence, Suboxone should be avoided by people who are:
- Under the age of 16
- Allergic to buprenorphine or naloxone
- Have asthma or other serious breathing problems
- Diagnosed with liver disease
Individuals should also inform their healthcare provider about the following medical conditions before starting Suboxone to ensure that the treatment is safe:
- Sleep apnea
- Enlarged prostate
- Abnormal curvature of the spine that affects breathing (scoliosis)
- Gallbladder problems
- Adrenal gland problems
- Thyroid problems
- Head injury, brain tumor, or seizures
- Alcohol use disorder (AUD)
- Pregnant or breastfeeding
Taking Suboxone during pregnancy can expose your unborn child to neonatal abstinence syndrome after birth. In addition, buprenorphine in Suboxone has also been observed to pass into breast milk. Thus, women who are breastfeeding, pregnant, or planning to get pregnant must inform their healthcare provider about their condition before starting Suboxone treatment.
Side Effects of Suboxone
Suboxone side effects can range from mild to severe. And most of these side effects generally dissipate within a few days or weeks. Some of the most common side effects of Suboxone include:
- Weakness or fatigue
- Back pain
- Stomach pain
- Mouth numbness
- Mouth redness
- Increased tolerance
- Physical dependence
If these symptoms persist and worsen over time, consult your healthcare provider immediately.
Some of the severe side effects of Suboxone include:
- Severe allergic reaction
- Breathing problems
- Hormone issues (adrenal insufficiency)
- Liver damage
- Withdrawal symptoms
Although severe side effects are uncommon, they may necessitate immediate medical intervention.
Medications to Avoid During Suboxone Treatment
Suboxone can induce severe side effects and life-threatening medical conditions and interfere with the effectiveness of certain medications when they interact. Thus, it’s important to inform your healthcare provider of all medications and supplements you are currently taking.
Medications that negatively interact with Suboxone include:
- Cold or allergy medicines
- Opioid pain medicines or prescription cough medicines
- All other benzodiazepines not commonly listed
- Muscle relaxants
- Sleeping pills
To improve the success of your Suboxone treatment and prevent any potential negative reactions throughout treatment, your healthcare practitioner will advise you of any potential risks associated with the medications you’re taking.
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