Opiate abuse and addiction (including addiction to heroin and prescription painkillers) present complications when use is discontinued or if the familiar amount is reduced. For this reason, withdrawal symptoms are often treated and managed with other medications. A few years after its initial introduction in the US in 1947, methadone was adapted from its traditional use as a pain reliever to treat opiate addiction. Methadone is now both well-established and well-known. Buprenorphine is newer to the scene, and it acts in a similar manner but with fewer potential side effects.
Buprenorphine is an opiate partial agonist, which means that it does not cause the same high degree of pleasurable effects characteristic of heroin or methadone. Even low doses of buprenorphine can stop the emergence of withdrawal symptoms related to opiate abuse. Buprenorphine has a built-in “ceiling effect,” such that the amount of intake above moderate dosing will not have a different effect. For this reason, buprenorphine has a lower risk of abuse, and milder side effects compared to other opiates.
Buprenorphine, in combination with the drug naloxone, is known by its brand name Suboxone. Naloxone is non-addictive and has no effect if users do not have opioids in their system. In 2002, Suboxone was approved for treatment of opioid addiction in the US (and in Europe in 2006). Suboxone is available in pill form and also as a dissolvable film.
Both buprenorphine and naloxone are opioids (also classified as narcotics), and clinical trials have shown that this drug combination is as effective as methadone. Research shows that Suboxone does not have the sedative effect nor do high doses cause the high that is characteristic of methadone.
As Suboxone is associated with fewer risks compared to methadone, and reportedly just as effective, it is clinically used as an alternative to methadone treatment.
Although Suboxone is intended to help stop opiate (or opioid) addiction, there has proven to be a proverbial fly in the ointment when it comes to its use. Suboxone has become increasingly prescribed, which has helped to fuel the diversion of Suboxone into the hands of non-prescribed users. Unfortunately, some lawful prescription holders recognize economic value in Suboxone, and sell or barter their pills on the street market.
According to some reports that factored in interviews with doctors and street buprenorphine users, most illicit users of Suboxone take this drug to self-medicate the withdrawal symptoms from other narcotics. The danger is that Suboxone can help keep an opioid abuser using these dangerous drugs because the withdrawal effects are minimized. Aware of this information, some drug dealers reportedly sell heroin and Suboxone together. A great testament to the power of addiction is that someone would buy both a poison and an antidote, and consume them one after the other.
As Suboxone is now well known on the street, it has acquired different nicknames, including:
- Box or boxes
- Sub or subs
According to the National Pain Report, in 2011, approximately nine million prescriptions for Suboxone or buprenorphine products were filled in America. As lawful prescriptions help to supply the street market, the risk of abuse increases. In 2010, over 50 percent of 30,000 hospital visits involving buprenorphine were due to misuse of the medication. As coroners do not usually test for buprenorphine, an accurate account of the number of overdose deaths cannot presently be determined.
Signs of a Suboxone overdose can be detected and include:
· Coughing/hoarseness · Dizziness
· Feeling hot/warm · Fever or chills
· Headache · Lower back pain
· Sweating · Painful urination
An in-depth article in The New York Times on the pros and cons of buprenorphine puts a human face to the tragic side of the abuse problem. In 2010, 20-year-old Miles Malone of Maine died after using buprenorphine recreationally with friends. Malone, who was already reportedly intoxicated, consumed two Suboxone tablets sublingually and also smoked marijuana. He fell asleep later on that night, not to awake again. The medical examiner concluded that Malone passed away from buprenorphine toxicity.Aside from marijuana, no other drugs or alcohol were in his system – although the level of buprenorphine appeared high for only having taken two pills. Malone’s friend, also in his 20s, was sentenced to 71 months in jail for unlawfully distributing the fatal doses of buprenorphine.
Getting Treatment for Suboxone Abuse
Compared to other drugs of abuse, Suboxone is unique in that it is most often abused to maintain use of another opioid. Suboxone is an addictive drug, which means that when use is discontinued, or there is a decrease in the amount of regular use, withdrawal symptoms will manifest. During detox, in addition to treating the Suboxone withdrawal, addiction specialists will also need to safely treat addiction to all other opioids that are being abused, which may include heroin, methadone, or prescription pain relievers such as OxyContin or Vicodin. Treatment for opioid abuse is complex, and it should be carried out in a structured rehab program.
Our veteran staff of addiction specialists across all FRN facilities has decades of experience treating opiate addiction. Our rehab services are always adaptive to the needs of each client and can provide the care necessary to treat abuse of Suboxone and other buprenorphine products. Call us today to learn more about how we can help you or your loved one start a new life in recovery.
Further Reading About Treatment for Suboxone Abuse
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David W. Newton is a board certified pharmacist and also has been a board member for boards of examiners for the National Association of Boards of Pharmacy since 1983. His areas of expertise are primarily pharmaceuticals as well as cannabinoids. You can read an article about his expertise in CBD on the National Library of Medicine.
Reviewed by: Kim Chin and Marian Newton