Treatment with Suboxone
Suboxone’s Use in Addiction Treatment
Despite the havoc that opioid addiction can wreak on individuals’ lives, many people are hesitant to quit due to their fear of a painful withdrawal and the distressing cravings that may follow.
MAT augments behavioral therapy and other rehab supports with the use of medication(s) to provide comprehensive substance use treatment.1,7
In the 1960s, methadone began being utilized as part of MAT, as it reduced withdrawal symptoms and, via its pronounced cross-tolerance development, blocked some of the euphoric "high" that would potentially be experienced with additional opioid misuse (thus decreasing the likelihood of continued drug use behavior and providing a break in the compulsive cycle of addiction.)2 While this method proved effective, it became somewhat prohibitive a few years later when new laws went into effect that required individuals to be in an opioid treatment program (OTP) to receive this type of treatment.2
Suboxone activates the opioid receptors but not to the same degree as many other abused opioids such as heroin and prescription painkillers.
The Drug Addiction Treatment Act of 2000 (DATA 2000) allows qualified doctors to prescribe opioid medications to treat addiction.2,7 Suboxone (a branded treatment formulation that combines buprenorphine and naloxone)3 is one such medication impacted by this law. It was approved as an opioid addiction treatment drug to be prescribed by qualified doctors, but only after meeting certain restrictions put in place by the Act. As a result, Suboxone can only be prescribed by a Suboxone doctor, a physician who has completed training and met the certification requirements for this privilege,2 and the Act caps the number of patients that doctor can treat with buprenorphine to 30 for the first year after completing certification.4 Thereafter, they can prescribe buprenorphine to 100 patients, unless they have applied to increase that limit to 275 under the Office of National Drug Control Policy Reauthorization Act of 2006, a modification to DATA 2000.4
Purpose of Buprenorphine and Naloxone
The buprenorphine and naloxone in Suboxone each have a specific purpose:
- Buprenorphine is a partial opioid agonist, which means it activates opioid receptors but not to the same degree as many other abused opioids such as heroin and prescription painkillers—meaning it imparts enough of an opioid effects to alleviate withdrawal and cravings without eliciting a pronounced, rewarding high. This works to break the pattern of compulsive drug-seeking.
- Naloxone, an opioid antagonist, is included in order to discourage people from injecting Suboxone to get high. If Suboxone is injected by an opioid-dependent individual, the naloxone in the drug will not only block the desired opioid high but could send the user into precipitated withdrawal.5
Should I Use Suboxone?
Suboxone may be appropriate for you if: 2
- You are struggling with opioid dependence.
- You are motivated to stop using opioids.
- You have a stable environment in which to recover (which ideally includes supportive relationships and resources to help you engage fully in treatment.
Suboxone may not be right for you if:2
- You are not physically dependent on opioids.
- You have mental health conditions that are not currently being addressed and/or you have suicidal thoughts.
- You are pregnant.
- You also struggle with alcohol dependence.
- You have had an adverse reaction to Suboxone in the past.
- You are taking medications that might adversely interact with Suboxone, such as naltrexone.
- You have abused Suboxone or methadone in the past.
- You have certain medical conditions that might contraindicate treatment.
To make sure that Suboxone is a good choice for you, it’s important to speak openly and honestly about your medical and psychiatric health history. Always disclose any past diagnoses and medications you take—Suboxone could interact dangerously with certain drugs.2 Also, make sure your Suboxone doctor is aware of your frequency and most recent use of opioids so they can determine the safest and most effective time to begin treatment.2
If you are struggling with an addiction to opioids, Suboxone may be able to help as part of a comprehensive treatment program or OTP, or as prescribed by a Suboxone doctor in an office.
The two major benefits of Suboxone treatment include:5,6,7
- Reduction in cravings and the painful withdrawal syndrome associated with heroin and other opioid withdrawal.
- Stabilization of symptoms, allowing for focus on addiction treatment, including behavioral therapy.
Often, opioid-addicted individuals seeking maintenance therapy with Suboxone are put on waiting lists at clinics that offer that treatment. During this waiting period, opioid use is likely to continue, accompanied by all the dangerous consequences of that use.
Fortunately, a trial conducted by the National Institute on Drug Abuse (NIDA) found that giving waitlisted individuals controlled access to buprenorphine reduced their illicit opioid and injection drug use during the waiting period. NIDA is looking to replicate these results in larger trials.8
In the short-term, Suboxone can produce side effects such as: 3
- Difficulty sleeping.
- Blurred vision.
- Mouth numbness or redness.
- Tongue pain.
- Stomach pain.
- Back pain.
Also, even though Suboxone doesn’t elicit the same kind of intense high as other opioids, it is still a partial opioid agonist, so there is the potential for developing physical dependence and addiction to the treatment drug itself.2 The chance of becoming addicted to Suboxone may be increased if you misuse the drug by taking it in higher doses or more frequently than prescribed. As such, it is important to take Suboxone exactly as prescribed.1
Where Can I Find Suboxone Doctors?
If you have decided that Suboxone is a treatment option you would like to pursue, you can begin by searching for a Suboxone doctor qualified to prescribe this medication.2
Remember that the use of Suboxone as prescribed by a physician in a doctor’s office should be part of a larger treatment program that includes counseling and therapy.1 This is an important component of treatment to ensure that you address any underlying issues that may have fueled your addiction.
You can also search for Opioid Treatment Programs that utilize Suboxone therapy. These programs should be certified by SAMHSA.
Am I Really Sober if I Use Suboxone?
The word sobriety in and of itself can have different meanings depending on who you are talking to. While some physical dependence will remain while you are on Suboxone (which may eventually be tapered off), cravings and compulsive use behaviors are reduced.1,6,7
Indeed, there has been some controversy over the use of MAT in recovery. Advocates say it is an essential component in recovery for huge numbers of people since opioid addiction is a medical disorder with a neurological basis.7,9 From this perspective, the use of Suboxone is not just substituting one drug for another but rather a safe and controlled way of recovering from opioid addiction.9
You need to do what works best for you, and a good starting place is discussing your options with your treatment provider.
On the other hand, some programs adhere to a policy of complete abstinence from substances and may view using opioid medications as trading one addiction for another.
Ultimately, you need to do what works best for you, and a good starting place is discussing your options with your treatment provider or a Suboxone doctor. While being entirely free of any substance may be something that you strive for in the future, the important thing is that you are getting help for your addiction and working to improve your overall functioning.
Looking for Treatment? What to Ask About
Not every rehab or outpatient program will incorporate the use of Suboxone, so it's important that you ask about it ahead of time if you want to utilize this medication as part of MAT.
Other things to ask potential treatment programs include the following:
- Do you take my insurance?
- Do you offer any options for financing or do you utilize a sliding scale to account for people with fewer financial resources?
- Does your program incorporate medical detox?
- What are your staff's qualifications?
- When do you typically begin the use of medications and how long do you recommend a patient stay on a medication like Suboxone?
It's always a good idea to ask any questions you have prior to picking a program. Don't wait until you get into a facility to bring up your concerns.
- Substance Abuse and Mental Health Services Administration. (2019). Buprenorphine.
- U.S. Department of Health and Human Services. (2004). TIP 40: Clinical Guidelines for the Use of Buprenorphine in the Treatment of Opioid Addiction: Treatment Improvement Protocol (TIP) Series 40.
- United States National Library of Medicine. (2017). MedlinePlus: Buprenorphine Sublingual and Buccal (opioid dependence).
- Substance Abuse and Mental Health Services Administration. (2017). Apply to Increase Patient Limits.
- Sigmon, Stacey C., Bisaga, Adam., Nunes, Edward V., O’Connor, Patrick G., Kosten, Thomas., Woody, George. (2012). Opioid Detoxification and Naltrexone Induction Strategies: Recommendations for Clinical Practice. Am J Drug Alcohol Abuse, 38(3), 187-199.
- Ling, Walter., Mooney, Larissa., Torrington, Matthew. (2015). Buprenorphine for Opioid Addiction. Pain Manag, 2(4), 345-350.
- Substance Abuse and Mental Health Services Administration. (2017). TIP 43: Medication-Assisted Treatment for Opioid Addiction in Opioid Treatment Programs.
- National Institute on Drug Abuse. (2017). Buprenorphine Benefits Waitlisted Seekers of Opioid Treatment.
- National Institute on Drug Abuse. (2018). Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition): Is the use of medications like methadone and buprenorphine simply replacing one addiction with another?