- Addiction & recovery
All About Suboxone Medication
Vanessa de la Cruz, MD
October 25, 2021
The prolonged use of opioids in a manner that causes clinically significant distress or impairment is known as opioid use disorder (OUD). OUD is a debilitating disease that has plagued our nation for many years. Although significant steps have been taken to curb the rise of opioid addiction, more than 90,000 opioid overdose deaths have occurred during the 12 months leading up to September 2020. According to provisional data from the Centers for Disease Control and Prevention (CDC), this is the highest number of overdose deaths ever recorded within 12 months. This alarming rise in fatal overdoses highlights the need for more accessible treatment services that promote prolonged recovery. And studies indicate that the use of medications for opioid use disorder (MOUD) combined with counseling and behavioral therapies is the most effective solution for treating OUD. And one of the primary medications utilized in MOUD treatment is Suboxone.
What Is Suboxone and How Does It Work?
Suboxone is a prescription medication approved by the U.S. Food and Drug Administration (FDA) in 2002 to treat opioid use disorder. Suboxone contains two primary ingredients: buprenorphine and naloxone in a 4:1 combination.
Buprenorphine is a partial opioid that blocks opioid receptors and reduces cravings. And the second ingredient, naloxone, help reverse the adverse effects of opioids and reduces the risk of misuse and overdose. Together, these ingredients work to reduce cravings and withdrawal symptoms associated with opioid addiction.
Suboxone is a schedule III controlled substance available as sublingual tablets and film strips. Suboxone can only be prescribed for MOUD purposes by doctors who have received special training and certification from the U.S. federal government.
Suboxone works by interacting with the same brain receptors as other opioids like heroin, morphine, and oxycodone. However, Suboxone isn’t as addictive as heroin or prescription opioid painkillers. This medication has helped many individuals return to a life of relative normalcy and safety after a period of unsafe or uncontrolled substance use.
How Should I Take Suboxone?
The half-life of the opioid being misused determines when Suboxone treatment begins. For example, OxyContin and heroin have a short half-life and leave the body in a couple of hours. Suboxone is usually prescribed at least 12 hours after the last dose of short-acting opioids and at least 24 hours following the last dose of long-acting opioids. The use of Suboxone before this period can lead to precipitated opioid withdrawal symptoms (sudden onset of intense opioid withdrawal syndrome).
The sublingual film strip or tablet should not be crushed, bitten, or swallowed but rather dissolved under the tongue or between the inner cheeks. You will be advised to wait until the medication is completely dissolved before eating or drinking anything. The medication should start working within a few hours after the first dose and last anywhere from 24 to 36 hours.
The first dose of Suboxone is administered during the acute withdrawal phase, as it helps alleviate severe symptoms of opioid withdrawals. Once you overcome the withdrawal phase, you will gradually transition to the maintenance phase under the guidance of your healthcare provider.
Taking the following precautions while using Suboxone will ensure the best treatment outcomes:
- Only use the medication as prescribed.
- Store Suboxone at room temperature, away from moisture and heat. Store the sublingual films in the foil pouch.
- Refrain from sharing Suboxone with another person, especially someone with a history of substance misuse and addiction.
- Other brand-name versions of buprenorphine/naloxone are not interchangeable with Suboxone (for example, Suboxone tablets require a different dose than Zubsolv buccal film). When switching brands, be aware of your medication’s buprenorphine exposure and the dose adjustments required.
- Follow directions on the prescription label carefully.
- Missing doses can reduce the effectiveness of Suboxone.
- Always consult your doctor before stopping Suboxone use.
Keeping yourself informed and observant will help you get the most out of your Suboxone treatment and minimize negative side effects.
Side Effects of Suboxone
Suboxone may cause side effects that can range from mild to severe. Some of these side effects may subside in a matter of days or weeks. The following list contains some of the most common side effects that may occur while taking Suboxone.
- Nausea and vomiting
- Muscle pain
- Muscle aches
- Stomach pain
- Irregular heart rate
- Loss of appetite
- Runny nose
- Weakness or fatigue
- Loss of coordination
- Burning tongue
- Redness in the mouth
- Blurred vision
If these symptoms persist or worsen over time, consult your healthcare professional immediately. Your physician can help by adjusting your dosage or provide you with an alternative medication.
Serious side effects of Suboxone can include:
- Severe allergic reaction
- Capacity to cause dependence
- Liver damage
- Severe withdrawal symptoms
- Adrenal insufficiency
- Slow breathing or shallow breathing
Serious side effects of Suboxone are rare. However, if you experience any of the symptoms mentioned above, contact your healthcare provider and seek medical treatment immediately.
Suboxone can also cause a severe allergic reaction, including anaphylaxis in certain individuals. If you experience any of the following symptoms, seek medical advice and treatment immediately.
Allergic reactions to Suboxone may include:
- Troubled or shallow breathing
- Swelling of lips, tongue, or throat
- Skin rash or hives
Candidates for Suboxone Treatment
The U.S. Department of Health and Human Services (HHS) has established a list of criteria for physicians to consider when evaluating candidates for the use of buprenorphine (including Suboxone) for MOUD treatment. And the primary criteria is that individuals must be diagnosed with opioid dependence. In addition to their diagnosis, they must also be committed to their treatment program.
Giving up a substance that activates the brain’s reward center is not a simple task, and healthcare professionals understand the gravity of this situation. Treatment acceptance, on the other hand, has proven to be effective in the recovery process. As a result, the person must, at the very least, be willing to follow the treatment plan and safety protocols. In order to make an informed decision about whether or not to utilize Suboxone, they must also be aware of other treatment options. An ideal candidate should be aware of the advantages and disadvantages of Suboxone.
Suboxone may not be the best treatment option for everyone. As such, the following individuals may not be suitable for Suboxone treatment:
- Individuals who have signs of intoxication or withdrawal.
- Individuals who are taking other medications that may interact with buprenorphine.
- Individuals who are at high risk of relapse.
- Individuals who are allergic to buprenorphine or naloxone.
- Psychiatrically unstable individuals (actively suicidal or homicidal).
- Individuals with certain medical conditions such as sleep disorders, enlarged prostate, urination problems; severe liver disease or kidney disease; abnormal curvature of the spine that affects breathing; head injury, gallbladder, adrenal gland, or thyroid issues.
Medications to Avoid While Taking Suboxone
Suboxone is both safe and effective when used as prescribed; however, it can cause serious health complications or adverse effects when used in conjunction with other medications.
Medications that can have negative interactions with Suboxone include:
- Opioid-containing medications.
- Medicines for motion sickness, irritable bowel syndrome, or overactive bladder.
- Benzodiazepines such as Valium, lorazepam, alprazolam, Xanax, Klonopin, and Ativan.
- Medications that make you sleepy or slow your breathing (sleeping pills, muscle relaxer, medicine for mental illness).
- Medications that impact the body’s serotonin levels (stimulants or antidepressants).
It’s critical to inform your doctor about any medications you’re taking, including prescriptions, over-the-counter medications, vitamins, and herbal supplements while you’re on Suboxone.
How Effective Is Suboxone Treatment for Opioid Use Disorder?
Suboxone is an effective medication in treating opioid dependence and addiction. It’s also effective at keeping individuals motivated and helping them progress through their treatment.
Some of the key benefits of Suboxone include:
- Decrease in opioid cravings
- Decrease in relapse rates
- Suppression of opioid withdrawal symptoms
- Low risk of misuse
According to the National Institutes of Health (NIH), many individuals addicted to opioid painkillers who took Suboxone tablets had a 49% reduction in opioid misuse. However, the effectiveness of a medication like Suboxone is also determined by how long people stay in treatment.
Experts may have different theories on how long Suboxone treatment should last. However, there is no evidence to support the argument that Suboxone should only be used for a limited period of time rather than being kept on it continually. Hence, the duration of Suboxone treatment should solely depend on each individual’s needs and requirements.
Suboxone can produce similar withdrawal symptoms to other opioids during abrupt discontinuation. As a result, individuals on Suboxone treatment are carefully weaned off the medication if the decision is made to discontinue it.
Suboxone can only be prescribed through the Suboxone REMS Program by doctors who meet specified criteria and have been given a unique identification number that is included on every prescription. So consult a doctor about Suboxone treatment and how it can benefit you in your recovery process.
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