Since the introduction of Suboxone to the American market, Suboxone therapy has become a primary treatment for opioid use disorders in the United States. Suboxone addiction therapy is now in use in treatment centers worldwide. However, understanding Suboxone therapy is less straightforward than other therapies. Both providers and patients must take time to understand how Suboxone works to determine if Suboxone therapy is the correct treatment choice for an opioid use disorder.

What Is Suboxone?

Understanding what Suboxone is, how Suboxone works and what Suboxone is used for can be tricky at first. Suboxone is the trade name for a combination drug that contains the opioid buprenorphine and the opioid blocker naloxone in a 4:1 ratio. It is commercially produced as a tablet that is designed to be taken under the tongue and absorbed into the bloodstream, since buprenorphine is not available to the body when swallowed.

Buprenorphine acts on the body’s primary opioid receptor, the mu-opioid receptor, in a limited way that caps the drug’s effects. Despite these limits on its maximum effects, however, Suboxone has been consistently shown to work very well in treating opioid use disorders.  

Suboxone has approval from the United States Food and Drug Administration (FDA) to treat opioid use disorders. Opiates are called “opioids” if they were created in a laboratory, and opioid addiction is the severe form of an opioid use disorder. Thus, what Suboxone is used for, at least primarily in the U.S., is the treatment of opioid addiction. Though not FDA-approved for this purpose, Suboxone is also used increasingly for chronic pain management.

Background and History

The history of Suboxone dates back to the late 1960s, as the British pharmaceutical company now known as Reckitt Benckiser tried to synthesize an opioid that could keep the positive effects of morphine while reducing its negative effects. The compound that would eventually become buprenorphine showed success in treating laboratory animals that showed physical dependence on opioids.  

By 1978, buprenorphine was approved as an injectable pain-relieving medication in the United Kingdom. Five years later, the sublingual version that would come to be known as Suboxone (after naloxone was added) became commercially available. Over the next 15 years, the use of buprenorphine became commonplace in the treatment of pain in humans and for post-operative veterinary care. In the 1990s, buprenorphine was studied in the U.S. for treating opioid dependence after European studies and clinical experience appeared promising.

The history of Suboxone has had a substantial effect on American policies for opioid addiction treatment. In 2000, Reckitt Benckiser helped the United States Congress draft special legislation called the Drug Addiction Treatment Act (known as DATA 2000). This allows buprenorphine to be prescribed by providers in a physician’s office for the treatment of an opioid use disorder if that physician has undergone specialized training. Methadone, by contrast, can only be prescribed for opioid use disorder if it is done within a federally licensed opioid use disorder treatment facility.

Use in Treating Addiction

By the 1980s, clinical trials were underway in Europe to test the use of Suboxone for opiate withdrawal. These early trials employed short-term Suboxone use for opiate withdrawal symptoms and found that the drug helped reduce or eliminate opioid cravings and virtually all opioid withdrawal symptoms.

Now, care for those with opioid use disorders can be directed toward the short-term use of Suboxone for opiate withdrawal symptoms. Long-term use can help regulate the body’s dependence on opioids and reduce or eliminate harmful addictive behavior.

Starting a Suboxone Treatment Program

The effectiveness of Suboxone is greatly dependent upon timing, so it is important to know when to start Suboxone. Unlike other medications used to treat an opioid use disorder, a person who is physically dependent on opioids has to be in withdrawal to begin Suboxone. If a person with an opioid use disorder is not at least in mild withdrawal when taking it, Suboxone will deactivate any other opioids present within the body and cause a severe withdrawal. Staff in a Suboxone program will check to ensure that withdrawal has begun before administering the medication. Suboxone usually relieves withdrawal symptoms within an hour.  

Side Effects of Suboxone

What are the side effects of Suboxone? Since Suboxone is an opioid, it can have side effects common to the opioid class:

  • Respiratory depression
  • Nausea
  • Vomiting
  • Sedation
  • Headache
  • Sweating
  • Dry mouth
  • Constricted pupils
  • Decreased libido
  • Urinary retention

Possible Interactions

By itself, Suboxone is unlikely to cause respiratory problems. Suboxone interactions with drugs that depress the central nervous system can slow down breathing and make breaths more shallow.

Suboxone can interact with certain drugs or foods in a way that increases Suboxone blood levels. To assess for Suboxone drug interactions, it is important for a health care provider to know if a person with an opioid use disorder is taking the following:

  • HIV medications
  • Clarithromycin
  • Erythromycin
  • Telithromycin
  • Antifungal medications
  • Diltiazem
  • Verapamil
  • Cimetidine
  • Grapefruit juice

Taking Suboxone While Pregnant

Women who would like to consider taking Suboxone while pregnant should consult with an OB/GYN doctor or an addiction medicine specialist. They can help you determine whether or not you can take Suboxone while pregnant.

Suboxone is rapidly becoming the preferred choice in the medical community when treating opioid use disorder in pregnant women who require medication. It is also used to treat newborns who are born with opioid withdrawal symptoms to opioid-dependent mothers. Suboxone has roughly equal effectiveness to methadone in treating opioid use disorders, and women who take Suboxone while pregnant report far more days free from opioid use than those who do not.

Risks Associated with Suboxone Use

There are four significant risks associated with Suboxone use: suboxone addiction, opioid withdrawal, opioid overdose and inability to adequately control acute pain with other opioids.

The risk of overdose using Suboxone is lower than it is for using other opioids, but it can still be significant. Similarly, the risk of addiction to Suboxone is lower than it is for other opioids, because of the cap on the maximum effect of buprenorphine. Despite being lower risk compared to other opioids, the risk of Suboxone addiction is still present.

What to Do in Case of Overdose

Suboxone overdose, like all opioid overdoses, is a medical emergency. If combined with another drug that slows and shallows breathing, such as benzodiazepines like diazepam (Valium) or alprazolam (Xanax), the risk for fatal Suboxone overdose dramatically increases. If possible, naloxone (commonly prescribed as Narcan) should be administered as soon as possible to anyone suspected to be experiencing a Suboxone overdose.

In all cases of a Suboxone overdose, emergency services like 911 should be immediately activated, and further treatment should take place within a hospital. Repeat doses of naloxone may be necessary since its anti-opioid effects wear off within one hour.

In case of a suspected Suboxone overdose, there should be a high suspicion for the presence of other medications or drugs as well. Suboxone overdose by itself is relatively uncommon because it has a cap on its maximum effect. Because of this, Suboxone overdose is unlikely when it is taken in its intended way. Suboxone overdoses tend to be less lethal than that of other opioids.

Additionally, the naloxone molecule within Suboxone helps counteract buprenorphine that has been administered intravenously. This makes a Suboxone overdose unlikely even if Suboxone is administered through an IV. Subutex, a buprenorphine product that does not contain naloxone, does not offer this protection against intravenous injection. As a result, IV administration of Subutex is more dangerous than Suboxone.

Get More Information on Suboxone

If you or a loved one has lost control over opioid use, Suboxone may be a treatment option for you. The Recovery Village has extensive resources to help you immediately address the physical symptoms of opioid withdrawal, as well as the ability to help you identify and address some of the underlying causes of opioid addiction.

If you or a loved one needs help for an opioid use disorder, call The Recovery Village today. Our staff of caring professionals is ready to help you. The call is free and confidential, and there is no obligation to commit to treatment.

    

Campbell, N.D., Lovell A.M. The history of the development of buprenorphine as an addiction therapeutic. Annals of the New York Academy of Sciences, 2012. Accessed April 15, 2019.

Chen KY, Chen L, Mao J. Buprenorphine-naloxone therapy in pain management. Journal of Anesthesiology, 2014. Accessed April 15, 2019.

Kraft WK, Adeniyi-Jones SC, Chervoneva I, et al. Buprenorphine for the Treatment of the Neonatal Abstinence Syndrome. New England Journal of Medicine, 2017. Accessed April 15, 2019.

McCance-Katz EF, Sullivan LE, Nallani S. Drug interactions of clinical importance among the opioids, methadone and buprenorphine, and other frequently prescribed medications: a review. American Journal of Addiction, 2010. Accessed April 15, 2019.ScienceDirect.com. “Buprenorphine.” 2018. Accessed April 17, 2019.

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