If you or someone you know is struggling with opioid use disorder (OUD), Suboxone might be a helpful tool in the recovery process. Suboxone is a prescription medication approved by the U.S. Food and Drug Administration (FDA) in 2002, used to reduce cravings for potent opioids such as heroin, fentanyl, and oxycodone. In this article, we’ll explore what Suboxone is, how it works, how it is taken, and things to remember when taking it.
Suboxone is a relatively new medication for opioid use disorder that has become more prevalent since its approval in 2002. It is classified as a schedule III controlled medication with a moderate risk of dependence. Therefore, only certified medical professionals can prescribe this medication. Suboxone is not intended to cure opioid addiction, but it plays an important role in the recovery process. Typically, Suboxone treatment programs involve behavioral therapy, counseling, and psychological support as part of a “whole person” approach to addiction treatment.
Suboxone contains a combination of two drugs, buprenorphine and naloxone, that work together to reduce the severity of withdrawal symptoms and dependence on opioids. Buprenorphine is an effective opioid pain reliever that activates the same brain receptors as other potent opioids. However, it is also a partial opioid medication, meaning it has a lower potency and effect compared to other opioids. This function helps minimize opioid cravings and withdrawal symptoms without the full opioid potency or effect.
On the other hand, naloxone is an opioid antagonist (inhibitor) that completely blocks opioid receptors in the brain. This function helps rapidly reverse the effects of opioids if Suboxone is crushed and injected to help reduce the risk of overdose and relapse. Naloxone is generally used in emergency situations as a medication to counteract an opioid overdose. The combination of these two drugs provides a low-risk potential for misuse and overdose.
Suboxone is available in several forms:
Missing Suboxone doses can make the medication less effective. If you forget to take a dose, do so as soon as you remember. If your next dose is approaching, however, forgo the missing dose. Do not double dose to compensate for the missed dose. Only take the dose that has been prescribed to you. If you’re unsure, talk to your doctor.
The buprenorphine in Suboxone has an exceptionally long elimination half-life compared to other opioids. Elimination half-life refers to the amount of time it takes for half of a single dose to leave the body. For buprenorphine, this period lasts 24 to 42 hours, meaning that it can take over seven to nine days for Suboxone to leave the body completely.
Many factors can contribute to how long Suboxone stays in the system. These include:
In addition, depending on the duration of treatment, traces of buprenorphine can remain detectable in the body for longer periods.
While Suboxone is an effective medication for addiction treatment, it does possess the risk of side effects. It is important to understand the potential side effects of Suboxone and how to manage them.
The most common side effects of Suboxone include:
The severe and less common side effects of Suboxone include:
If an individual experiences any of these severe side effects, they should seek emergency medical attention immediately.
The prolonged use of any opioid medication, including Suboxone, can lead to physical dependence. However, this possibility is lower than that of other opioids. In addition, Suboxone doesn’t have the same sedative properties as other opioids; therefore, it’s less likely to cause cravings.
Unlike other opioids, buprenorphine in Suboxone contains a “ceiling effect.” As a result, while a person’s tolerance to buprenorphine can grow, they cannot overcome that tolerance by compulsively increasing the amount of medication they take. This effect also helps reduce the risk of misuse.
Suboxone is a relatively safe medication, but overdose is a possibility if the medication is misused. As such, combining Suboxone with other substances like benzodiazepines or alcohol may bypass the ceiling effect and cause an overdose.
Symptoms of Suboxone overdose may include:
Misuse of this medication can cause severe side effects, including a fatal overdose. Individuals suffering symptoms of an overdose must seek immediate medical attention to avoid fatal consequences.
In the event of a Suboxone overdose, Narcan/naloxone should be administered to the person who has overdosed immediately. The next step would be to call 911 (even if the person appears to wake up or come out of it because the effects of naloxone could wear off) and wait with the person for an ambulance to arrive. Check with your prescriber or pharmacist for information on how to obtain Narcan/naloxone.
Prolonged use of Suboxone can cause withdrawal symptoms if the medication is abruptly stopped. For this reason, health care practitioners progressively reduce Suboxone doses to alleviate the risk of withdrawals.
Suboxone withdrawal is relatively less intense than other opioid withdrawals and includes symptoms such as:
Suboxone withdrawals generally occur within 24 hours of the last dose, peak within 72 hours, and last for approximately a month.
A suboxone doctor will conduct a comprehensive evaluation to determine your candidacy for Suboxone treatment. During this evaluation, your treatment provider will also consider your recovery goals and medical history to develop a complete treatment plan.
Suboxone may be an appropriate treatment option for individuals who are:
If an individual is not a suitable candidate for Suboxone treatment owing to an underlying health concern, health care professionals can prescribe alternative medications to combat opioid use disorder.
Suboxone treatment may not be a suitable treatment option for individuals with certain health complications. Hence it’s important to inform your healthcare provider if you have any of the following health conditions before taking Suboxone: chronic breathing disorders, enlarged prostate, urination problems, liver or kidney disease, problems with the gallbladder, adrenal gland, or thyroid, head injury, brain tumor, or seizures, allergic to buprenorphine or naloxone, sleep apnea, and pregnant or breastfeeding.
Certain opioid-containing medications and over-the-counter herbal remedies or supplements can cause negative effects when taken with Suboxone. Below is a condensed list of medications that interact with Suboxone.
Inform your health care provider of all medications and supplements currently in use before starting Suboxone treatment.
Substance use disorders during pregnancy can result in low birth weight, preterm birth, and fetal death. Thus, it’s important to seek appropriate MOUD treatment to mitigate the risk of harmful consequences of opioid dependence during pregnancy. According to the National Center for Biotechnology Information (NCBI), Suboxone treatment during pregnancy has been proven to be a safe and effective medication for OUD. Suboxone effectively lowers relapse rates and opioid overdoses when combined with behavioral therapy while improving birth outcomes in opioid-dependent mothers.
However, buprenorphine during pregnancy can expose newborn infants to neonatal abstinence syndrome (NAS) after birth and can also be passed into breast milk. For this reason, women who are breastfeeding, pregnant, or planning to get pregnant must inform their healthcare professionals about their condition before starting Suboxone treatment. It’s important to note that infants born to mothers who used Suboxone correctly during pregnancy experienced minor fetal distress and other symptoms after birth.
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