There are different medications available for opioid addiction and dependence, and one of those is called Suboxone. Suboxone is a brand-name medication combining buprenorphine and naloxone. The use of Suboxone can be for someone who’s addicted to prescription opioids such as oxycodone or hydrocodone, as well as someone dependent on illegal opioids like heroin.
The following provides an overview of using Suboxone for opioid addiction, what to know about the potential downsides and side effects of Suboxone, and how to get Suboxone.
An Overview of Suboxone for Opioid Addiction and Dependence
What's In This Article?
Before going into the specific ways Suboxone is used to help people with opioid addiction and dependence, there is a distinction to be made. Addiction and dependence are not the same things. Addiction refers to a chemical addiction to opioids. This occurs when someone’s brain neurochemistry changes in response to repeated opioid exposure. The reward response in the brain is triggered, and their use of opioids is ultimately out of their control.
Dependence is a separate condition, and it can occur with or without a chemical addiction to opioids. Dependence is primarily a physical and physiological condition. With repeated exposure to opioids, a person’s brain and body depend on them to function in a way that’s the “new normal.” When someone stops using opioids, especially cold turkey, they will likely go through withdrawal.
Primarily Suboxone is a medication used to deal with the symptoms of opioid dependence and withdrawal. However, before someone can receive addiction treatment for opioids, they have to fully detox so in that way Suboxone can help with opioid addiction as well.
Medication-Assisted Treatment
Suboxone is a medication that falls into the larger category of medication-assisted treatment or MAT. Medications are one way researchers, doctors, and public policymakers are working to slow the overdose deaths occurring as the result of opioid addiction and dependence.
Mediations that are used for the treatment of opioid use disorder include:
- Methadone
- Buprenorphine
- Naltrexone
These medications can call into different categories including opioid agonists and partial agonists. Methadone is an opioid agonist that helps reduce or eliminate withdrawal symptoms and drug cravings. Methadone works on the same brain receptor sites as other opioids, although in a weaker way. If someone uses methadone as they’re supposed to, they shouldn’t feel euphoria, so it reduces the potential for abuse. Methadone can only be distributed through specialized programs for opioid dependence treatment.
Buprenorphine is a partial opioid agonist, so it’s even less potent than methadone in terms of activating opioid receptor sites. Buprenorphine also reduces cravings and withdrawal symptoms without euphoria. With buprenorphine, people don’t have to visit specialized clinics to receive it.
There are also medication-assisted treatments that are defined as opioid antagonists. Naltrexone is an opioid antagonist. This means rather than activating opioid receptor sites, naltrexone blocks the opioid receptor sites from being activated.
Naltrexone and opioid antagonists work differently from other medication-assisted treatments because they prevent euphoria or other pleasurable effects of opioids rather than helping with cravings and withdrawal symptoms.
What Is Suboxone?
So, what is Suboxone for opioid addiction and Suboxone for opioid dependence?
Suboxone is a brand-name, prescription drug that comes as a sublingual film. The active ingredients are buprenorphine and naloxone. Naloxone is the drug used in brand-name Narcan, and it reverses the effects of opioid receptors. Naloxone works by binding to opioid receptor sites and then blocking the effects of other opioids such as heroin or prescription pain medications.
While the buprenorphine in Suboxone is a partial agonist that attaches to the same receptor sites as other opioids, naloxone helps prevent abuse of the drug. The idea is that if someone sues over a certain amount of Suboxone, or try to use it other than how it’s intended, such as injecting the drug extracted from the film, a person will go into immediate opioid withdrawal.
The overall theory behind Suboxone is that it helps block drug cravings and withdrawal symptoms but that there is a built-in protection element that helps prevent abuse of this drug, which isn’t something present with methadone.
Key Suboxone Facts
The following are some important facts to know about Suboxone for opioid addiction and dependence:
- Suboxone is considered less habit-forming than methadone, so it’s often the preferred treatment for opioid use disorder
- Suboxone is unique because it doesn’t require a prescription from a specialized treatment center—instead, you can get a prescription from your doctor
- Suboxone is typically used at the start of addiction treatment and then throughout the recovery process, although everyone will have a unique treatment plan
- As with other medication-assisted treatments, Suboxone is meant to be used as part of a comprehensive treatment program including behavioral therapy, such as cognitive-behavioral therapy for best outcomes
- Using Suboxone on its own isn’t considered an addiction treatment because it doesn’t address the many complex and underlying factors that are part of addiction
- Usually, a doctor will start someone on a higher dose of Suboxone as they’re going through withdrawal to combat the uncomfortable symptoms, and then they’ll gradually reduce the doses over time
How Do You Use Suboxone?
Suboxone is typically administered as a film. The film is placed under the tongue where it dissolves. When someone places the Suboxone film under their tongue they shouldn’t’ chew or swallow or, nor should they talk because all of these factors can affect the absorption of the medicine.
The Suboxone “Ceiling Effect”
Suboxone has something called a ceiling effect—this is because of the buprenorphine. There is a certain point where even if someone continues to use higher doses of buprenorphine, they won’t get increasing effects.
What Are the Side Effects of Suboxone?
While Suboxone can often be a valuable part of a larger treatment plan for opioid use disorder, as with any drug there are potential side effects. Possible side effects of Suboxone for opioid addiction and dependence are:
- Numbness of the mouth
- Mouth pain
- Headache
- Dizziness
- Numbness
- Drowsiness
- Insomnia
- Stomach pain
- Constipation
- Vomiting
- Concentration problems
Severe side effects of Suboxone requiring immediate medical attention include:
- Fainting
- Severe dizziness
- Irregular heartbeat
- Changes in mental state or mood such as hallucinations or confusion
- Slow or shallow breathing
- Extreme drowsiness
- Problems waking up
Can You Overdose on Suboxone?
While medication-assisted treatments can help people struggling with opioid use disorder, they often have a potential for abuse as well as overdose. Methadone is frequently involved in opioid overdoses for example.
So what about Suboxone—is it possible to overdose? It’s fairly rare that someone would overdose on Suboxone, but it is still possible. This is especially true if someone has a low opioid tolerance, or if they combine Suboxone with other central nervous system depressants. Sometimes people who don’t have an opioid tolerance when they use Suboxone may also feel high from it.
If someone mixes Suboxone with CNS depressants, it may bypass the ceiling effect of the drug. Commonly used central nervous system depressants include benzodiazepines like Xanax as well as alcohol. Cocaine, while it’s not a depressant, can also have dangerous effects when used along with Suboxone. It can reduce the amount of buprenorphine in the system of someone on Suboxone, and lead to immediate withdrawal symptoms.
How Can You Get Suboxone?
While you can get Suboxone from a doctor outside of a specialized clinic, you do need to see a doctor who is trained to prescribe Suboxone. However, there are some restrictions as to how doctors can administer buprenorphine treatment. For example, there are federal laws limiting how much a doctor can prescribe at any one time.
If you’re interested in finding a doctor in your area who can prescribe Suboxone, you can use the National Alliance of Advocates for Buprenorphine Treatment (NAABT) patient/provider matching system.
The Substance Abuse and Mental Health Services Administration (SAMHSA) also has a practitioner locator that you can use to find providers in your area that can provide buprenorphine for opioid use disorder.
The Suboxone information site also features a tool to find a treatment provider using your zip code.
Another option aside from going to a private doctor is to go to a treatment facility offering buprenorphine or Suboxone to treat opioid use disorder and substance use disorder, as part of a larger complete treatment protocol.
Sources:
Suboxone.com. “What is Suboxone Film?” Accessed April 29, 2019.
NIH National Institute on Drug Abuse. “Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition).” January 2018. April 29, 2019.
NIH National Institute on Drug Abuse. “Medications to Treat Opioid Use Disorder.” June 2018. Accessed April 29, 2019.
