- Mental Health»
- Drug Addiction
Buprenorphine(Subotex,Suboxone) Vs Methadone : "The choice is given".
Drug addiction. One of the most dangerous health issues than can hit - ANYONE. Drug addiction can be cured or treated if the proper therapy is applied on individual. As I've wrote in one of previous hub, therapies and treatments for drug addiction are, or at least should be, individualized - different from person to person.Doctors are usually that there is no "magic cure" for opiate/heroin addiction, and that getting off from heroin or opiates should be an long-term and step-by-step process. Medicines that are most commonly used for treating heroin addicts, along with those addicted to OxyContin,OxyCodone,HydroCodone,Percocet,Lortab,Palladone.... , ARE (as I've said- most commonly) : Buprenophine (as an "first-line" medication) and Methadone(the "Gold Standard", and the "second,third, line" medication). In some countries, there are also, registered spectrum of medicines for treating opiate addiction is spread with "slow-release" morphine pill's or capsules, hydromorphone tablets made with special "O.R.O.S" anti-abuse technology or in I.V intravenous ,I.M intramuscular or an hydromorhponeimplant with constant release of active substance.Additional medications for treating opiate addiction, along with upper-mentioned, are dihidrocodeine, and diacetyl-morphine (diamorphine British name-same substance ) registered for H.A.T - Heroin Assisted Treatment.
Have you ever used an opiate (heroin,methadone,vicodin,percoced,lortab,oxicodone,hidrocodone...)
Resime - In bottom line :
Methadone is an full synthetic opiate agonist.Very effective at treatment of any kind of opiate addicts, as it is effective also in short - 21 day - detoxification.Buprenorphine, introduce just few years ago, did show some really promising results, and as the result of many clinical trials - buprenorphine is approved for maintenance and detox in majority of world countries. Patients often question the efficiency of the buprenorphine, as methadone showed as an "gold standard" in treatment of addicts. Buprenorphine showed a as lot less euphoric medicine, but still very specific. It has an "maximum line of effect" (let's call it that), which means when dose reaches 32-38mg, the buprenorphine amount added beyond that "line" is INEFFECTIVE.So, You can take, as many pills as you want, after you reach the maximum line, but they will still remain inactive and you will notice NO difference at all or what so ever.Heroin addicts, find buprenorphine, SUBOTEX (not suboxone), pills handy in cases when they can't reach or get their dose of "H". I.V users, usually crush pills, suck in to syringe, trough the filter, and then shoot it. Than, after agencies for monitoring drugs, realized the abuse - made the suboxone, impossible to shoot and ineffective if it is IV-ed.
So, now we know that Methadone is SURELY more euphoric, but is it more toxic than buprenorphine? - Nobody actually knows, one is sure - the "Suboxone" version of Buprenorphine IS MORE TOXIC than Methadone, itself, because of naloxone in it - that really destroys kidneys and liver. What's more effective, methadone or buprenorphine? - The answer to this question is different from person to person. Someone finds buprenorphine more suitable, someone finds methadone more suitable.It's the matter of tolerance, the "T" of heroin usage,along with many other factors like speed of metabolism,liver state (because of enzymes) etc...
When it comes to the withdrawal, methadone withdrawal is longer - for sure, because of the fact that methadone accumulates in fat tissue. If you were, for example, on long term maintenance (T of treatment = >2yrs.) , methadones half life will be up to 48h . After two days, you will start to feel the real withdrawal.Some of the patients, say that methadone withdrawal is worse than heroin. Yes it is. Heroin is, in basis, SEMI-SYNTHETIC opioid and it is much less toxic than methadone - in PURE edition like that in Switzerland for treatment - diacetyl-morphine or that in Britain - diamorphine.
Methadone (MMT) VS. Buprenorphine
Methadone Maintenance Treatment, is available for 40. years! It is most spread, used, and effective treatment on Earth (official records of W.H.O) with 40% of patients in it, from the all that are included in some kind of treatments.In last few years, new medicine is stating to be used as an alternative to methadone - buprenorphine. Buprenorphine,the substance itself, is an partial agonist and partial opiate antagonist.What does it means?-It means that it has an effect of an opiate but, in same time, it has an effect of an "anti"-opiate and it has an really huge, and unpleasant, reaction when it's taken along with an other opiate! That's why, buprenorphine, is effective - but dangerous. Because of it's high affinity to opioid receptors, it knocks out any available/remaining opiates and it binds to them. If the person, that took an opiate AFTER taking the buprenorphine - in best scenario : he or she won't feel a thing. The most common scenario, and more dangerous and much more unpleasant scenario is: 10 times worse withdrawal symptom effect when opiate is taken. The second scenario, usually occurs IMMEDIATE, if opiates are still in body and buprenorphine is administrated "on them" - buprenorphine taken in to body, while opiates haven't leave the body yet!
While methadone (at least should) have an mild feeling of euphoria, when it's administrated - buprenorphine doesn't have it, or it has - but on lot less level. The buprenorphine advantage is in it's addiction level, and the time while addiction is developed.Also, buprenorphine has a slow-time developing of tolerance.The buprenorphine, itself, is really good pain-killer and medication for treating heroin/opiate addicts.Now, in next few lines I will describe you HOW DOCTORS SELECT WHAT'S THE PROPER TREATMENT FOR THE INDIVIDUAL; The "T" letter is an variable for how long has the person/addict has been abusing opiates.
As an first line(usually first official treatment), for people less then a year of opiate abuse (T= <1yr.) - patients usually get an treatment with opiate antagonist based medicine; such as "Nalorex" (naltrexone hcl, naloxone with slow-release mechanism).
As an second line (second try) of an treatment, with patients more then one year but less than 3 (T= >1, <3) - patients usually get the partial agonist, partial antagonist opiate based medicine which is - buprenorphine. Buprenorphine is sold under few different trademarks, usually as "Subotex", "Suboxone", and the generic one - "Buprenorphine..." ( the "..." marks mean the manufactures name). Patients usually get confused when it's about making a difference between "Subotex" and "Suboxone". The main difference is next: under the name of "Subotex" patients will find the medicine made of buprenorphine itself , with some inactive ingredients like color,flavor,etc - nothing else! Now, the "Subotex" 's cousin - "Suboxone" ,is an "anti-abuse" version of the same medicine, with same active ingredient: buprenorphine, BUT with additional ingredient called "naloxone hydrochloride" - that is ACTIVE ONLY WHEN IT'S TAKEN INTRAVENOUSLY. So, when doctors or agencies that have a job of monitoring controlled substances noticed the increase of "Subotex" abuse - they've decided to add the substance to the original medicine (Subotex) - naloxone - that is active ONLY when it's taken intravenously ; and the combination of buprenorphine + naloxone = "Suboxone". So, the making of, and "Suboxone" itself, is lot more harm-full for our body than "Subotex" or "Buprenorphine..." !! Naloxone or "Naltrexone" (oral active cousin) are really dangerous and bad for liver and kidneys, so because of that, these kind of medicines "Naltrexone" or "Suboxone" CAN NOT be described to persons with kidney decease or liver failure(decease) like Hepatitis,etc...In these cases, full opiate agonist based medicines like Methadone and slow-relese morphine pills or capsules are introduced into treatment for maintenance.