Drug Addiction Treatment: Suboxone & Subutex
For a long time, methadone detox or methadone maintenance coupled with Narcotics Anonymous meetings was the only way to treat drug abuse long-term on an outpatient basis. Clients with a bed at an inaptient rehab facility, however, had access to a variety of methods and medications, including Buprenorphine. Buprenorphine hydrochloride, commonly known as Buprenex, is an injectable analgesic that has been used for the treatment of opiate addiction since the 1980s. Buprenex is effective on any opiate (heroin, oxycodone such as Oxycontin and Percocet, hydrocodone such as Vicodin, morphine, oxymorphone, fentanyl) whether it is smoked, taken into the body intranasally or taken in through intravenous mainlining. Due to the fact that it needed to be directly injected into the bloodstream in order to be effective, it has been unavailable for doctors to prescribe to clients on an outpatient basis or for methadone clinics to offer to their outpatients as an alternative to methadone.
Enter Suboxone and Subutex. In October 2002, the FDA approved these buprenorphine-based medications for release in the United States. Although also intended for use at inpatient facilities, the breakthrough was the FDA allowing Suboxone to be prescribed by federally approved doctors and psychiatrists, and allowing pharmacies to fill these scripts. The reason for the change in procedure was that Suboxone and Subutex took a high dose of Buprenorphine and condensed it into a small 2-mg or 8-mg pill, which would be ingested sublingually by holding it under the tongue.
The difference between Suboxone and Subutex
The only difference between Suboxone and Subutex is that Suboxone contains naloxone, an opiod-receptor antagonist. It is commonly misunderstood that naloxone is put in Suboxone to block the effects of other opiates if the patient attempts to get high during treatment, and although this is certainly an advantage, the additive's main purpose is to prevent abuse of the drug. In order to begin Suboxone therapy, the patient must refrain from using opiates for at least 24 hours before beginning treatment. If someone is switching from methadone to Suboxone, it is recommended that he be at a methadone dose of 30mg or less. If he does not refrain and is not in full-fledged withdrawal, or is not at the methadone minimum at the time of the first dose, the medication will precipitate even worse withdrawals as the medicine is administered. This is because the naloxone (which is used by emergency response teams in cases of overdosing) attacks the drug by binding itself to any opiates present in one's system. Subutex, on the other hand, can be taken sooner, when only mild withdrawal is beginning, and is often prescribed to pregnant women where full-fledged withdrawal can threaten the baby's life or cause miscarriage.
How it works
When opiates are taken into the body, dopamine is released which produces a feeling of pleasure and euphoria. As the drugs wear off, the receptors which received the opiates are left empty, causing withdrawal symptoms to begin. The buprenorphine in Suboxone attaches to the empty receptors and stops them from feeling the pangs of craving and withdrawal. It is a partial opioid agonist, which means it completely halts withdrawal without producing the euphoria and unconsciousness that is counterproductive to a healthy, functioning lifestyle. At its best, buprenorphine also blocks other opiates from attaching to the empty receptors and does not allow a high to be felt.
Unlike methadone clinics, which require clients to come in every day to take their dose in front of nurses, after the first Suboxone/Subutex dose is monitored by a doctor in his office, a one-month prescription may be filled that will allow the patient to take the pill in the comfort of his or her own home. Although a 2mg, 8mg or 16mg dose can potentially last anywhere from 48-72 hours, almost all doctors instruct that it be taken every single day to ensure that a proper, active level of medication is running through the system at all times. One of the benefits of buprenorphine-based drugs is that they have a low ceiling effect, making it less likely for individuals to overdose on the medicine. Buprenorphine also has a limited effect on breathing, also making it less likely to induce overdose via respiratory distress.
Over 3.7 million Americans have either tried opiates or are currently addicted to them, but 400,000 of those suffering have successfully completed a buprenorphine program in the five years since it was approved for distribution in the United States. Although considered a "miracle drug" by the thousands who have escaped the grip of addiction through buprenorphine treatment, Suboxone and Subutex were primarily designed for, and are most effective on, those suffering from low level opiate dependency. Those with a high degree of dependency may benefit best from a different form of treatment such as methadone maintainence. Below are some helpful links citing resources for the different types of addiction therapies.
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