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Buprenorphine, Subutex and Suboxone

Update: The brand-name drug Subutex was discontinued for use in the United States.

Quitting opioid use is challenging for those who have been addicted to it. While the symptoms of acute opioid withdrawal can make it physically challenging to endure the abstinence, the craving for drug use and the need to feel the high pose additional psychological challenges to those trying to quit. For many, medication-assisted treatment (MAT) represents a relatively holistic substance abuse treatment intervention because, through both pharmaceutical and behavioral therapeutic approaches, it not only helps manage the physical withdrawal symptoms from opioids, but also addresses cravings and other mental challenges to long-term recovery.  For the treatment of opioid dependence, buprenorphine is available as either a generic medication or, until recently, under the trade name Subutex. It continues to be marketed in combination with naloxone as Suboxone. Any of these formulations may be administered to help you face the challenge of quitting opioid drugs and increase your chances of long-term recovery.

Buprenorphine: A New Solution for Opioid Dependence

From the 1960s until the year 2000, methadone was the primary option for people seeking narcotic replacement therapy to minimize withdrawal symptoms. Methadone is an opioid agonist that is prescribed under controlled circumstances to treat the symptoms of opiate withdrawal. In 2000, buprenorphine became the first narcotic drug that could be prescribed by certified physicians for the treatment of opioid dependence under the Drug Addiction Treatment Act.1

What Is Buprenorphine?

Buprenorphine belongs to a class of drugs termed opioid partial agonists. Like heroin and other drugs derived from morphine, buprenorphine links with opioid receptors in the brain to modify pain perception and elicit feelings of well-being, but its effects are not as strong as a full agonist, such as heroin.For many years before it was approved for opioid addiction treatment, buprenorphine was prescribed as a pain reliever. When used as prescribed for opioid dependence, buprenorphine can replicate the actions of opioid drugs without the associated rewarding high, making it a relatively safe option as a recovery medicine.A review of clinical studies concluded that buprenorphine at any dose retained people in treatment better than placebo, and at high doses (16 mg), it reduced illicit opioid use effectively compared with placebo.When prescribed at fixed doses (more than 7 mg per day), it was found not to be different from methadone prescribed at fixed doses (40 mg or more per day) in retaining people in treatment or in suppression of illicit opioid use. However, it was found to be less effective than methadone in retaining people in treatment if prescribed in a flexible dose regimen or at a fixed and low dose.2 Another review concluded it was more effective than other medicines, such as clonidine when used for opioid withdrawal management.3

How Can Buprenorphine Help Me in Recovery?

Buprenorphine can be an effective component of an opioid addiction treatment program when combined with behavioral modification and counseling by:
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  • Helping you stay physically comfortable in the early stages of recovery by easing withdrawal symptoms.
  • Blocking cravings for heroin or other street opioids.
  • Minimizing the risk of relapse.
  • Helping gradually and safely reduce dependence on street drugs or powerful, abused prescription opioids.

Use of buprenorphine for management of opioid addiction allows you to regain a state of mind that is free of drug-induced highs and lows. It frees you from thinking all the time about the drug, which allows you to focus on important lifestyle changes to keep you on the road to recovery.

Is Buprenorphine Better than Methadone?

Unlike methadone, which is classified as a Schedule II substance under the Controlled Substances Act, buprenorphine is classified as a Schedule III substance, which means that its potential for abuse is lower than methadone. Methadone may only be prescribed by doctors who are registered under the Drug Enforcement Agency’s Narcotic Treatment Program, and the medication may only be dispensed at authorized clinics.4

Buprenorphine, on the other hand, may be prescribed by any doctor who has received specialized training and certification from the Center for Substance Abuse Treatment. Buprenorphine is increasingly considered to be a safer, more readily accessible treatment option than methadone.

Buprenorphine’s effects have a ceiling, so they cease to increase beyond a certain dose. This means it carries relatively fewer chances of fatal respiratory depression, even in the case of an accidental overdose. It may also be superior to methadone in managing opioid withdrawal in an inpatient setting since it produces quicker resolution of withdrawal symptoms, and, consequently, higher rates of treatment completion.3

What Is Subutex and How Does It Work?

Subutex was the brand name for buprenorphine that was discontinued in 2011 due to its overwhelming ability and tendency to be abused. It was administered as sublingual tablets, which were placed under the tongue and allowed to dissolve. When taken in prescribed doses, typically Subutex did not generate the same level of euphoria, drowsiness or central nervous system (CNS) suppression as street narcotics. Subutex was not intended to be taken on an as-needed basis, but under a certified doctor’s supervision and used as directed to produce the desired effects.

However, many users abused Subutex by crushing the tablets and snorting or injecting them to achieve a more powerful effect. When Subutex was injected intravenously or snorted in large doses, it had the ability to suppress breathing, cause dizziness, confusion or unconsciousness. This extreme danger to users precipitated its recall.

If you are ready to take the first step toward recovery now, please call 1-888-744-0789 Who Answers? to discuss your treatment options with a rehab support specialist.

What Is Suboxone?

Suboxone is the commercial name for buprenorphine combined with naloxone. Naloxone is an opioid antagonist, which means that it blocks the opioid receptors in the brain and prevents opioid agonists and partial agonists from connecting with these receptors and having an effect.

Suboxone was developed in response to a need to discourage users from abusing buprenorphine by injecting or snorting the drug to get high. Naloxone was added to the buprenorphine to keep the user from feeling the effects of Suboxone if it is injected.

Suboxone, photo by a katz | Shutterstock.comWhen Suboxone is taken sublingually, you don’t feel the effects of naloxone. However, if you crush the drug and try to inject or snort it, the naloxone will block the pleasurable sensations that high doses of buprenorphine can produce. Suboxone has recently become available as a film, which further reduces the potential for abuse.

Medication therapy with buprenorphine or Suboxone is only one aspect of successful rehabilitation. To get clean and remain abstinent, you need the best exclusive addiction treatment program that not only addresses the physical aspects of opioid dependence, but the personal, emotional and social ramifications of this disease.

How Can Suboxone Help Me In Recovery?

The combination treatment of Suboxone offers all of the same benefits of buprenorphine monotherapy in the treatment of opioid addiction. It offers an additional advantage by reducing the risk of diversion and intentional misuse sometimes reported with buprenorphine tablets. It does so via the addition of naloxone, which serves to block the effects of an otherwise enhanced high that people might seek to obtain by crushing the tablets to be either injected or snorted.

If you are ready to take the first step toward recovery now, please call 1-888-744-0789 Who Answers? to discuss your treatment options with a treatment support advisor.

Sources

  1. Substance Abuse and Mental Health Services Administration. (2000). Drug Addiction Treatment Act of 2000.
  2. Mattick, R.P., Breen, C., Kimber, J., Davoli, M. (2014). Buprenorphine maintenance versus placebo or methadone maintenance for opioid dependence. Cochrane Database System Review, 6(2), 2207.
  3. Gowing, L., Ali, R., White, J.M. (2009). Buprenorphine for the management of opioid withdrawal. Cochrane Database System Review, 8 (3), 2025.
  4. Drug Enforcement Administration. (2016). Opioid (Narcotic) Addiction Treatment Programs.
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