Overview of SuboxoneThe Suboxone Debate: Learn why use of Suboxone is a hotly contested issue.
Suboxone is a combination drug comprised of two substances:1,2
- Buprenorphine—a partial opioid agonist with a “ceiling effect” that keeps effects from increasing past a certain dose.
- Naloxone—an opiate antagonist used to reverse or block the effects of opiates in someone’s system.
Buprenorphine has been available for many years, but a major shift happened in 2002 when the trade formulations known as Subutex and Suboxone became approved in the US, and began being marketed for the treatment of narcotic addiction.2 Subutex (now discontinued) contained buprenorphine only, while Suboxone contains both buprenorphine and naloxone, also known as Narcan. From this point forward, doctors were permitted to prescribe the substance to individuals that were struggling with opiate addiction.2
In a similar way to methadone, Suboxone can decrease cravings and withdrawal symptoms will limit withdrawal symptoms and decrease the frequency and intensity of cravings.3 Buprenorphine is not a full opioid agonist like heroin or methadone and is considered to have a low overdose potential.3
Suboxone typically comes as a sublingual strip rather than a pill. This means it can be dissolved under the tongue discreetly without water to wash it down.1
Suboxone is considered a long-acting opioid because the effects can last for up to 3 days.4 Because of this, the risks of negative effects are lower since they are more dispersed and less intense. For example, at higher doses Suboxone is shown to have a lower risk of related breathing problems than some other drugs used for opiate addiction management, including methadone.4
- Breathing problems.
The short-term, desirable effects of Suboxone include pain relief, a mild euphoria, and and a reduction in opioid cravings.4 However, as with any other substance, there are dangers. Taking too much/abusing it can lead to:1,4
- Respiratory depression.
Suddenly stopping use of Suboxone can elicit unpleasant withdrawal symptoms.
Side effects that may occur during a period of active use include:6
- Nausea and vomiting.
- Muscle aches.
While Suboxone is used in the treatment of addiction, the drug itself can lead to tolerance and dependence.1,4 Suddenly stopping use of Suboxone can elicit unpleasant withdrawal symptoms, such as:7
- Teary eyes.
- Dilated pupils.
The inclusion of the opioid antagonist, naloxone, in the medication can send someone who attempts to inject it into what is known as precipitated withdrawal—the very rapid or immediate onset of opioid withdrawal.1
Can I Become Addicted to Suboxone?
Suboxone is used in the long-term management of opiate abuse to end the pattern of abuse, but it actually can be abused itself. In fact, currently, aside from its prescribed use, Suboxone is a highly sought after drug of abuse because it can bring on opioid effects.6
Rather than being addicted to the heroin or prescription pills, people may become addicted to the Suboxone. Taking the drug for reasons other than its intended purpose increases the risk of becoming addicted or restarting the cycle of abuse and addiction.
Are There Long-Term Effects?
Suboxone abuse both directly and indirectly imparts some serious long-term effects that can affect both mental and physical health. Abuse can also cause overdose, which may result in:8
- Pupil constriction.
- Low blood pressure.
- Respiratory depression.
Chronic abuse may also cause anxiety, insomnia, and depression.1
With repeated misuse, an addiction may develop, which often causes problems like:
- Failing relationships.
- Trouble with responsibilities (e.g. parenting, work, school).
- Financial strain.
- Legal problems associated use such as stealing or driving intoxicated.
What Is Dependence?
Because Suboxone contains an opioid, it can lead to dependence. This means your body has come to depend on it to feel well and you will feel uncomfortable when you stop using it.
One of the key signs of Suboxone dependence is that you start to suffer from withdrawal after ceasing use of the drug. Because it is a long-acting opioid, early withdrawal might not begin until up to 36 hours from the last use.9
Withdrawal symptoms can mimic the flu, but they can last for more than a week.9 It is a sign that the opioid and its ultimately toxic influences are finally relinquishing their grip on a wide range of the body’s systems and functioning.
Suboxone dependence often requires a medically monitored detox period to keep the user comfortable and help protect them from relapsing to alleviate their symptoms.
Suboxone Addiction Treatment
The full range of Suboxone addiction treatment consists broadly of a detox stage, a therapeutic stage, and a longer-term recovery phase (which frequently consists of a number of post-treatment aftercare efforts). Conceptually, these stages may overlap to some degree.
Once your withdrawal is progressing, you can start the process of therapy. Whether the therapy is inpatient or outpatient, it will involve understanding the systems in place that triggered the addiction and what can be done to maintain life without the substance.
You may encounter different therapists with different styles during this process. For example, a therapist trained in cognitive behavioral therapy may ask about your thoughts and feelings to assess how these impact your behaviors. You might also be asked about your family and how you relate to others to identify the problematic relationships in your life. Additionally, a therapist will work to determine if the problematic drug use may have been a means of “self-medication,” or done in an attempt to manage other underlying mental or behavioral health issues.
A referral to a psychiatrist may be done to begin psychiatric medications to any concurrent mental health issues, if indicated. Evaluation by a mental health professional will help to identify any potential factors that may have lead to or reinforced ongoing drug abuse or addiction, as well as outline the therapeutic steps one can take to get off drugs.
The last stage is recovery, when the period of active addiction treatment concludes, and you are given the opportunity to move forward in your life. You can use the tools learned and the guidance received to stay sober.
Strategic aftercare planning will be implemented as most treatment programs near completion. Post-treatment, many benefit from ongoing counseling that is focused on relapse prevention, improved coping skills, and identifying health supports. It is helpful for those entering the long-term recovery phase to attend a regular support group like Narcotics Anonymous. These can provide valuable peer interaction, as well as the wisdom and support of a larger community when it is needed the most.
- Suboxone: Highlights of Prescribing Information.
- The National Alliance of Advocates for Buprenorphine Treatment. (n.d.). What Exactly Is Buprenorphine?
- National Institute on Drug Abuse. (2018). Opioid Addiction.
- Center for Substance Abuse Treatment. Clinical Guidelines for the Use of Buprenorphine in the Treatment of Opioid Addiction. Treatment Improvement Protocol (TIP) Series 40. DHHS Publication No. (SMA) 04-3939. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2004.
- Whelan, P. J., & Remski, K. (2012). Buprenorphine vs methadone treatment: A review of evidence in both developed and developing worlds. Journal of Neurosciences in Rural Practice, 3(1), 45–50.
- Substance Abuse and Mental Health Services Administration. (2016). Buprenorphine.
- B.M.Tripathi, P. Hemraj, N.K. Dhar. (1995). Buprenorphine Withdrawal Syndrome. Indian J. Psychiat* 1995,37(1), 23-25.
- Kumar R, Saadabadi A. Buprenorphine. [Updated 2018 Apr 15]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2018 Jan-.
- Substance Abuse and Mental Health Services Administration. (2018). Tip 63: Medications for Opioid Use Disorder.