WHAT IS SUBOXONE?
What is Suboxone?
Suboxone is a prescription medication that comes in a sublingual (under the tongue) tablet or sublingual film. Suboxone contains 2 ingredients: buprenorphine and naloxone.
Suboxone is prescribed to treat opioid (painkiller) dependence. In other words, it is used to treat addiction to narcotic drugs like codeine, morphine or Oxycontin. Suboxone is also commonly used to treat heroin addiction. It was approved by the FDA in 2002 and is a product of Reckitt Benckiser Pharmaceuticals, Inc.
Suboxone Tablets and Film each come in 2 strengths:
- 2mg/0.5mg (buprenorphine/naloxone)
- 8mg/2mg (buprenorphine/naloxone)
The "film" is the latest dosage form, approved in 2010. Patient surveys indicate that it tastes better, dissolves faster, and is generally preferred over the tablet version. Ahhh...the beauty of progress!
UPDATE: The tabs were withdrawn from the market, as the manufacturer claimed they were less safe than the film. The tablets are, however, now available in a generic form.
Substance addiction is a serious problem. Studies done not too long ago indicate that upwards of 2.4 million persons aged 12 and older had used pain relievers for "non-medical purposes" in the past year. "Non-medical purposes" means they were intentionally using the pain reliever NOT for pain relief...but rather for other euphoric effects. To put it bluntly, they were looking to get "drunk on drugs."
Although this article is essentially about Suboxone, I also want to communicate the fact that I know how devastating substance addiction can be. Pharmacists are not exempt from this problem, and I have seen the lives of more than 1 friend destroyed by addiction. If you are personally facing this problem, I want to encourage you to stick with the plan. I'm cheering you on!
Now, for those who want to know a few more details about what Suboxone is, please keep reading.
WHAT DOES SUBOXONE ACTUALLY DO?
Suboxone does 3 things:
FIRST, Suboxone prevents a patient from the uncomfortable withdrawal symptoms that would be experienced when abruptly stopping an addictive narcotic drug. The ingredient that does this is buprenorphine. Did you notice that this drug ends with "orphine" much like the drug "morphine?" That is because they are closely related. Buprenorphine actually has a much stronger attraction to the same "receptors" stimulated by narcotics. Thus, Suboxone is typically begun in a patient just as withdrawal symptoms begin to appear.
Another way to explain it is this: Narcotics, and similar drugs, make the brain happy. Like a child with a toy. When you take away the toy...the child gets angry! When you suddenly stop narcotics, the brain also gets angry! And it isn't pretty! In fact, it can be quite painful...and in severe cases, even fatal. Buprenorphine is like a "substitute" toy for that child. You take away the real toy, but you put a different (less harmful) toy in his hands...and he is okay with that. Your brain accepts "buprenorphine" as a reasonable substitute for the narcotic, and thus doesn't get angry with you.
SECOND, Suboxone blocks the effects of ingested narcotics on the brain. Buprenorphine accomplishes this also. Think of buprenorphine like a lock on the "pleasure" receptor in the brain which would be stimulated by narcotics. If a person tries to take such a substance, like Oxycontin for example, it will result in little to no effects. The narcotic cannot "break through" the effective "lock" put on those receptors in the brain. Buprenorphine does provide some amount of "euphoria" itself, but to a much lesser degree. To return to our "toy" example, buprenorphine is like putting a very fun & sticky toy into the child's hands. So sticky...he cannot put it down to play with any other toy, nor does he want to. Other toys have no influence...he is entirely committed to this new "sticky" toy.
THIRD, Suboxone has a special ingredient to prevent abuse, known as naloxone. Although buprenorphine produces very little "euphoric" effect when dissolved orally under the tongue, it could produce a much more potent effect if crushed and injected. To prevent this, the manufacturer has included naloxone. Naloxone, if injected, will produce immediate and severe withdrawal symptoms in someone who has been taking Suboxone or other narcotics. Naloxone, just to complete our "toy" example, is like a bully that comes along and takes away that sticky toy (bupenorphine) AND will not allow any OTHER toy into that child's hands either. The child gets VERY ANGRY! Welcome to instant withdrawal symptoms!
HOW TO TAKE SUBOXONE
Suboxone may be taken as a single daily dose. This makes Suboxone more convenient than using methadone for opioid addiction, which is typically taken 3-4 times daily.
The usual maintenance dose of Suboxone is 16mg/4mg (thus, 2 tablets or films of the highest strength formula).
Initiation: Often a patient will begin Suboxone therapy in a clinic or doctor's office. Sometimes therapy will begin with a product called Subutex (buprenorphine) which has NO naloxone, and thus is less likely to produce withdrawal.
Length of Therapy: A physician and patient will discuss how long therapy on Suboxone should continue. Often 3-6 months is considered appropriate, although longer or shorter treatments may also be appropriate.
Discontinuation: Therapy with Suboxone should be discontinued only under the advice and with the careful plan of your physician. Tapering is usually necessary.
SIDE EFFECTS AND OTHER PRECAUTIONS AND INFO
If you are asking "What is Suboxone?" then I suppose you may be considering this drug with your physician. In that case, let me give you a few final words about Suboxone side effects and some other important information.
SIDE EFFECTS: Side effects from Suboxone include loss of feeling in the mouth and tongue (temporary), headache, constipation, insomnia, pain and withdrawal. Remember...some of these "effects" are likely to actually be just a reaction to stopping the narcotics. The transition will still be uncomfortable for some patients.
SCHEDULE: Suboxone is classified as as Schedule III controled substance by the DEA. This means there will be some restrictions on the number of tablets/films that can be prescribed, and the number of refills that can be given. This will vary by State.
PRESCRIBERS: Only doctors who have been properly licensed for treating opioid addiction, according to the Drug Addiction Treatment Act, may prescribe Suboxone. To find such a doctor locally, visit the Suboxone website and click on FIND A DOCTOR.
INSURANCE: Not all insurance plans cover Suboxone. If not, you may need to pay for it yourself. Other insurance plans DO cover Suboxone, but sometimes require your doctore to complete a "Prior Authorization Request" in order to pay for the medication. This may take several days, and your pharmacy will contact the doctor about this.