Suboxone
Suboxone is a brand-name medication that combines buprenorphine and naloxone, primarily used for treating opioid addiction. Available in sublingual film or tablet form, it serves as a safer alternative to traditional treatments like methadone. Buprenorphine acts as a partial agonist at opioid receptors, which helps reduce cravings and withdrawal symptoms while minimizing the euphoric effects commonly associated with opioid misuse. The addition of naloxone is significant, as it blocks the effects of other opioids, thus deterring abuse. Suboxone is classified as a Schedule III controlled substance and is legally available in the United States, subject to regulations that facilitate its prescription in primary care settings. Despite its benefits, the medication is not without risks, including potential side effects similar to those of other opioids, such as nausea and dizziness. Advocates argue that broader access to Suboxone could help reduce stigma around medication-assisted treatments and encourage more individuals to seek help for opioid dependence. Overall, Suboxone plays a crucial role in opioid use disorder recovery while emphasizing the importance of responsible use to mitigate risks.
Subject Terms
Suboxone
ALSO KNOWN AS: Box; bupe; buprenorphine with naloxone; saboxin; sobos; stop signs; stops; sub; subs
DEFINITION: Suboxone Sublingual Film is the brand-name sublingual tablet or film consisting of buprenorphine and naloxone, used for the treatment of opioid addiction.
STATUS: Legal in the United States and worldwide
CLASSIFICATION: Schedule III controlled substance
SOURCE: Synthetic compounds derived from the thebaine alkaloid of the opium poppy
TRANSMISSION ROUTE: Sublingual
History of Use
The use of Medications for Opiod Use Disorder (MOUD) has been practiced for decades. Buprenorphine, an opioid substitute, has been available since the 1980s in injectable and sublingual dosage forms prescribed for pain management. Since 2002, sublingual formulations with and without naloxone have been used primarily as safer alternates to methadone in opioid detoxification and dependence programs. Subutex, a formulation containing only buprenorphine, is sometimes ground up and injected or inhaled by patients to maximize the euphoric effects of the drug. Suboxone, which includes naloxone in a one-to-four-part ratio with buprenorphine, limits the abuse potential of the drug since naloxone blocks the effects of opiates, such as heroin, morphine, fentanyl, and oxycodone. This prevents cravings and allows people to enter recovery, though immediate withdrawal symptoms can occur.
Use in the United States is limited by the Drug Addiction Treatment Act of 2000. A Risk Evaluation and Mitigation Strategy, approved by the US Food and Drug Administration (FDA), is available for the drug to ensure proper medication use and to limit abuse and diversion; this program allows primary care physicians to prescribe the medication, improving access to treatment. A transdermal patch containing buprenorphine (Butrans) is available for pain management only.
Effects and Potential Risks
Buprenorphine is a potent partial agonist at the mu (µ) opioid receptor. Because buprenorphine binds more strongly than other opioids to receptors in the brain, it limits the effect of opioids in patients taking buprenorphine and can effectively block the effect of high-dose heroin, making it ideal for opioid treatment programs.
The side-effect profile is similar to that of other opioids, including nausea, vomiting, constipation, sweating, headache, drowsiness, and dizziness; side effects are less frequent than with morphine. Respiratory depression is not likely to occur unless buprenorphine is taken with central nervous system depressants, such as alcohol or benzodiazepine; deaths have been reported in persons taking benzodiazepine who also inject buprenorphine products.
Naloxone is a mu (µ) antagonist used in opioid overdose, primarily in cases involving heroin or morphine. It is not an effective antagonist to buprenorphine because of the high binding affinity of buprenorphine to the opioid receptors. The drug combination is preferred in cases where unsupervised administration of the drug is occurring, as both buprenorphine and naloxone can block or reverse opiate effects from other opioids such as heroin, morphine, and methadone; intravenous misuse of Suboxone leads to immediate withdrawal symptoms in persons continuing to abuse other opioids.
Therefore, while abuse of Suboxone does occur, it is less likely since the euphoric effects are not nearly as strong as those of other opiates. Advocates for the drug believe greater access to Suboxone would help those who misuse other opiates ween themselves off these substances. These advocates believe stigmas surrounding MOUD prevent patients from seeking the proper treatment they need. If treatments were more readily available and socially acceptable, more patients would likely seek help.
Bibliography
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Grinspoon, Peter. "5 Myths About Using Suboxone to Treat Opiate Addiction." Harvard Health Publishing, 7 Oct. 2021, www.health.harvard.edu/blog/5-myths-about-using-suboxone-to-treat-opiate-addiction-2018032014496. Accessed 30 Aug. 2024.
Kahan, Meldon, et al. “Buprenorphine: New Treatment of Opioid Addiction in Primary Care.” Canadian Family Physician 57 (2011): 281–89. Print.
Lang Walter, et al. “From Research to the Real World: Buprenorphine in the Decade of the Clinical Trials Network.” Journal of Substance Abuse and Treatment 38, suppl. 1 (2010): S53–60. Print.
MacGillis, Alec. "The Wonder Drug: Why Are Drug Courts Denying Heroin Addicts the Medicine They Need?" Slate. Slate, 9 Feb. 2015. Web. 10 Nov. 2015.
Patient Information for SUBOXONE® (buprenorphine and naloxone) Sublingual Film (CIII), www.suboxone.com/. Accessed 30 Aug. 2024.
Reilly, Adam. "Suboxone: A Miracle Drug or Merely a Step in the Right Direction?" WGBH. WGBH, 9 Nov. 2015. Web. 10 Nov. 2015.
Svrluga, Susan. "The Drug Suboxone Could Combat the Heroin Epidemic. So Why Is It So Hard to Get?" Washington Post. Washington Post, 13 Jan. 2015. Web. 10 Nov. 2015.
“What Is Buprenorphine? Side Effects, Uses, Dose & Risk.” SAMHSA, 28 Mar. 2024, www.samhsa.gov/medications-substance-use-disorders/medications-counseling-related-conditions/buprenorphine. Accessed 30 Aug. 2024.