Suboxone is the trade name for buprenorphine/naloxone (Subutex is the trade name for buprenorphine alone). Bunavail and Zubsolv are other trade names for buprenorphine/naloxone. This is an effective FDA approved medication to Treat Opioid Addiction (Opioid Use Disorder). Buprenorphine/naloxone is taken sublingually to block opioid cravings and treat opioid withdrawal symptoms. It is most effective when taken in conjunction with appropriate counseling (examples include individual, intensive outpatient, partial hospitalization, and residential), and group support (including Alcoholics Anonymous/Narcotics Anonymous and SMART recovery).
Suboxone Treatment Effectiveness
Buprenorphine/naloxone can help individuals focus on living a healthy, positive, and productive life. It can prevent opioid overdoses and can reduce high-risk behavior that can lead to transmission of Hepatitis C and HIV. Many individuals that are treated with buprenorphine are able to end the cycle of opioid addiction and improve family relationships, resume their education, or find/resume steady meaningful employment.
When taken appropriately patients do not have cravings and they do not have withdrawals. They often report feeling “normal”.
A Complex Brain Disease
It is very important to know that addiction is a brain disease and when treated like a chronic medical illness, results are similar to other chronic medical illnesses such as hypertension, asthma, and diabetes.1,2 It often has its roots in genetics, mental health conditions, trauma, and unstable living situations. Effective treatment for Opioid Use Disorder involves appropriate medication-assisted treatment (MAT), counseling, and group support. It often involves treatment for underlying conditions such as depression, anxiety, and trauma. Family members may also need support.
How Does Suboxone Work?
Buprenorphine is a semisynthetic opioid partial agonist (which means it is a man-made opioid which has less ability to relieve pain and cause euphoria than full strength opioids like morphine, heroin, fentanyl, and oxycodone) which has a high affinity for the opioid receptor (this means that it binds tightly to the opioid receptor so that an individual can’t get the effects from full agonist opioids listed above). 3 It has a very long half-life, so it is only necessary to take it once daily. Buprenorphine is absorbed very well under the tongue, but it is not absorbed well if swallowed. It also does not absorb well if taken intravenously.
The second component of Suboxone is naloxone. This is an opioid blocker that reverses the effects of opioids. It does not absorb well under the tongue, but it does absorb well when taken intravenously.
The combination makes it hard to abuse. It must be started when the individual is in opioid withdrawal, or at least there are no full-strength opioids in the person’s system. If buprenorphine is taken too soon after a full-strength opioid it can precipitate opioid withdrawal symptoms.
Does It Cause Someone To Get High?
Buprenorphine does not cause a high in individuals who are dependent on opioids. It can cause a high in people who have never been addicted to opioids.
Does It Come In Any Other Forms?
Buprenorphine/naloxone is most commonly taken sublingually, but buprenorphine can be administered in a weekly skin patch (Butrans), a monthly injection (Sublocade) and an implant (Probuphine).
What Other Medical Treatment Options Are There?
Other forms of effective MAT are methadone maintenance (must be administered by a federally approved methadone clinic), and intramuscular naltrexone (Vivitrol).
Can It Be Used To Treat Chronic Pain?
Chronic pain is not an FDA approved indication for buprenorphine, however, evidence does support its use for chronic pain.4
Suboxone Treatment Side Effects
Buprenorphine should only be taken by individuals who are dependent on opioids. It can be dangerous if ingested by a child, so the medication must be kept locked up (this also minimizes the possibility that the medication could be damaged or stolen).
The most serious potential side effect is respiratory depression.
The most common side effects are constipation, headache, and nausea. Patients are encouraged to drink plenty of fluids.
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1. Volkow, N, G. Koob, and A. McLellan. Neurologic Advances from the Brain Disease Model of Addiction. N Engl J Med 2016;374:363-71
2. Mclellan AT, et.al. Drug Dependence, A Chronic Medical Illness, implications for Treatment, Insurance, and Outcomes Evaluation. JAMA 2000: 284:1689-1695
3. Coe, M. M. Lofwall, and S. Walsh. Buprenorphine Pharmacology Review: Update on Transmucosal and Long-Acting Formulations. J Addict Med 2019 Mar/Apr, 13(2):93-103:93-103
4. Khanna, I and S. Pillarisetti. Buprenorphine-an attractive opioid with underutilized potential in treatment of chronic pain. Journal of Pain Research. 2015:8, 859-70