What is Suboxone?
Suboxone is a medication used to treat opioid use disorder. Suboxone is a combination medication that contains two drugs, buprenorphine and naloxone. Both of these drugs are often prescribed separately to treat people suffering from opioid addiction. However, when they are combined they offer unique effects that are particularly effective at mitigating symptoms of opioid withdrawal.
The drug has been on the market since 2002, and a generic formulation of the drug has been available since 2018. Suboxone is generally taken using one of two routes of administration, either as sublingual tablets that go under the tongue or that dissolve in the cheek. Suboxone is an essential drug for treating opioid addiction, and it ranks as the 288th most prescribed medication in the United States.
Suboxone is generally prescribed as part of a medication-assisted treatment (MAT) plan to treat opioid addiction. When a person takes Suboxone, the drug reduces withdrawal symptoms for a period of approximately 24 hours. It mitigates cravings and eliminates some of the more physically and mentally arduous side effects of opioid withdrawal. However, it should be stressed here that Suboxone does not cure opioid addiction. Rather, it is prescribed as merely one component of a more comprehensive addiction treatment plan.
Medication-assisted treatment utilizes Suboxone to help individuals become more responsive and available for other treatment modalities, which generally include psychotherapy and support groups. It is important to take Suboxone only under careful medical supervision in the context of a comprehensive treatment plan. This generally entails enrolling in a medical detox center, inpatient program, or outpatient treatment center.
It may come as a surprise that the two drugs contained in Suboxone, despite being used to treat opioid use disorder, are in fact opioids themselves. Buprenorphine and naloxone, despite being opioids, affect opioid receptors differently than the more commonly abused recreational opioids. By reducing the effects of recreational opioids, buprenorphine and naloxone can be used to treat addiction.
Nonetheless, when misused or abused buprenorphine can be used to get high. The combination of buprenorphine and naloxone, however, is generally believed to have a lower potential for abuse and buprenorphine alone. While it is more difficult to abuse, people suffering from addiction are often motivated to devise inventive and creative ways of abusing drugs — and methods do exist for abusing Suboxone.
In the 1940s, methadone was introduced to the United States as a way of treating pain from severe injuries on the battlefield. It was quickly discovered, however, that methadone could be used to effectively treat people going through opioid withdrawal.
By replacing recreational opioids with methadone, people trying to end their opioid dependence could gradually reduce their dosages without experiencing the severe side effects that generally accompany withdrawal. This treatment became known as opioid replacement therapy, and methadone remained the primary drug used for this treatment for many years.
It would be many years before Suboxone emerged as a major competitor to methadone. The two components of the drug were developed independently and used successfully to treat opioid use disorder before they were combined into one medication.
The first component of Suboxone, naloxone, was initially patented in 1961. Naloxone was a revolutionary new drug. Researchers discovered that taking it could reverse the effects of an opioid overdose, thereby saving lives. In 1971, it was approved in the United States for treating opioid addiction and overdoses. In the 1990s, when heroin and other recreational opioids began to take more lives, public health officials worked to make naloxone more widely available.
15 states initiated pilot programs that distributed opioid abuse kits containing naloxone to medically untrained people. The idea was that if naloxone could be administered quickly and easily in non-hospital settings, overdoses could be prevented. The Centers for Disease Control and Prevention estimates that between 1996 and 2014, more than 26,000 potentially fatal overdoses were prevented by these naloxone kits.
Buprenorphine, on the other hand, wasn’t originally designed to be used in opioid replacement therapy. The process of developing buprenorphine began in 1969, when researchers at British company Reckitt and Colman began working to synthesize a new opioid that would retain the positive pain-reduction effects of opioids without negative side effects or a high potential for abuse.
After ten years, testing on animals demonstrated that they had successfully developed a new opioid that did not lead to the same levels of dependence as others. In 1978, buprenorphine became available in the United Kingdom. It was administered by injection and used to treat severe pain. The success of the drug soon led to the release of a sublingual formulation in 1982.
In the United States, however, buprenorphine was not available by prescription until 2002. In the years leading up to the drug’s approval in the United States, the pharmaceutical company that developed buprenorphine, Reckitt and Colman, lobbied Congress to pass the Drug Addiction Treatment Act (DATA), which made it legal for physicians to prescribe narcotics for the purpose of opioid detox.
Up until the passing of the Drug Addiction Treatment Act, Schedule III, IV, and V narcotics could not be prescribed by physicians except in specifically licensed inpatient drug addiction clinics. The passing of DATA paved the way for buprenorphine’s use in outpatient settings. Soon after the act was passed, the Drug Enforcement Agency reclassified buprenorphine from a Schedule V drug to a Schedule III drug, thereby increasing the regulation surrounding it. Nonetheless, in 2002 the Food and Drug Administration approved buprenorphine for treating opioid use disorders.
The combination of naloxone and buprenorphine in the form of Suboxone was approved by the FDA in 2002. The drug was designed to limit the abuse potential for buprenorphine. While buprenorphine is difficult to abuse when taken as prescribed, recreational drug users who misuse buprenorphine by injecting it are able to get high. Injecting naloxone, however, not only prevents overdose, it reverses the effects of the opioid high and sends people into withdrawal.
When naloxone and buprenorphine are combined in Suboxone, it is difficult to inject and therefore abuse the drug without sending oneself into immediate opioid withdrawal. Naloxone has a limited impact when taken sublingually, however, so the drug remains effective and naloxone does not interfere in the effects of buprenorphine when Suboxone is taken exactly as prescribed.
Due to its more limited potential for abuse, addiction treatment centers and medical professionals generally prefer the combination drug Suboxone over buprenorphine by itself. Nonetheless, the drug is not without its risks. Over the years, enterprising drug addicts have continued to devise ways to abuse Suboxone.
How is Suboxone Made?
Suboxone is developed in laboratories by pharmaceutical companies. Naloxone, a synthetic derivative of oxymorphone, works to antagonize opioids. Buprenorphine, however, is a semi-synthetic opioid derived from thebaine, an alkaloid of the poppy Papaver somniferum.
Buprenorphine is an opioid partial agonist. The two drugs are synthesized independently before scientists combine them in a lab. Suboxone and its generic formulations are available in two different forms that are both designed to be dissolved sublingually. The suboxone film is designed to be dissolved under the tongue or against the cheek. The suboxone tablet, which is also dissolved sublingually, is still available in some areas but has been discontinued, due to the ease with which children can accidentally ingest it.
Unlike many opioids, Suboxone is rarely produced in illicit labs. While there is a thriving blacket market demand for Suboxone, the illegal distribution of Suboxone mainly consists of people reselling their prescriptions. While the drug can be abused, it is generally not the preferred drug of abuse for people addicted to opioids. As such, illegal drug distributors and cartels rarely produce it themselves, though they have been known to engage in operations that make prescription formulations available to recreational users.
Suboxone Street Names
When Suboxone is taken as prescribed, it is generally referred to by its official brand name. Other common brand names for the product include Bunavail and Zubsolv. However, while the combination of buprenorphine and naloxone is also available in generic formulations, the drug is still sometimes referred to as Suboxone, due to the recognizability of the brand name.
When Suboxone is taken for recreational purposes or distributed by drug dealers, it often goes by other names. This is because illicit distributors aim to avoid detection by law enforcement authorities, and code words for the drug can make it more difficult for law enforcement agencies to track. Youth drug culture also has its own ever-changing vocabulary for drugs and drug abuse. Some of the more common names for Suboxone used in the context of drug abuse include:
- Big Whites
- Small Whites
- Stop Signs
Buprenorphine is uniquely effective as a drug for treating opioid dependence. A study conducted in Sweden demonstrated buprenorphine’s usefulness in addiction treatment. In the study, some patients were given buprenorphine and others were given buprenorphine for a short period followed by a placebo. The treatment failure rate for the patients given placebos was 100%, whereas only 25% of patients dropped out who were given buprenorphine consistently during the duration of the study.
Further analysis showed that patients who are given buprenorphine are 1.82 times more likely to stay in addiction treatment compared to placebo-receiving patients. Patients receiving buprenorphine were also 14.2% less likely to test positive on opioid tests. Most importantly, those who drop out of addiction treatment programs due to lack of buprenorphine access had a 20% mortality rate. These statistics demonstrate that buprenorphine can save lives.
A study conducted by the medical research company Cochrane found that the combination drug Suboxone is as effective as methadone when it comes to treating opioid dependence. The study showed that self-reported heroin use and positive opioid drug tests decreased to similar extents among patients on methadone and patients on Suboxone. However, while the two drugs have similar efficacy, Suboxone is uniquely useful because it can be prescribed by physicians on an outpatient basis, unlike methadone which can only legally be prescribed in licensed inpatient addiction treatment centers.
Suboxone is also significantly less dangerous than methadone due to its lower abuse potential. The Centers for Disease Control and Prevention estimates that 1 in 3 prescription opioid overdoses is due to methadone abuse. While methadone can indeed save lives when used properly, it takes an estimated 5000 lives every year. Taking Suboxone has a 90% lower mortality rate than taking methadone.
The need for effective medications like Suboxone that treat opioid dependence is clear. An opioid epidemic is currently devastating the United States and much of the world. Between 1999 and 2018, 450,000 people have died from opioid overdoses. The opioid epidemic has seen three different waves. The first one began in the 1990s when pharmaceutical companies lobbied doctors to increase prescriptions of synthetic and semi-synthetic opioid analgesics. In 2010, with the rise of affordable and widely available black tar heroin, deaths increased.
Beginning in 2013, fentanyl and other high potency synthetic opioids began to be illicitly produced and distributed, often contaminating other drug products as well. The US Department of Health and Human Services estimates that more than 130 people die every day as a result of opioid overdoses. In 2018 alone, approximately 2 million people in the United States were diagnosed with opioid use disorders. Without effective treatment programs in place that utilize drugs like Suboxone, these 2 million people are at risk of experiencing a life-threatening overdose.
How Does Suboxone Work to Treat Opioid Addiction
Suboxone can be prescribed by a physician on an outpatient basis or in the context of a medical detox center. The drug is generally used to help people detox from short-acting opioids, though it can also be used as part of an opioid replacement program on a long-term basis. Suboxone can help patients manage the symptoms of opioid withdrawal. Common symptoms of opioid withdrawal that Suboxone can reduce include:
- Sleep problems
- Gastrointestinal problems, such as diarrhea and vomiting
- Cold flashes and goosebumps
- Uncontrollable leg movements
- Muscle and bone pain
- Severe cravings
During the initial phase of Suboxone treatment, patients withdraw from their recreational opioid(s) of choice. During this phase, they may experience painful symptoms of opioid withdrawal, but these symptoms are mitigated by the effects of Suboxone. Suboxone helps in particular with reducing cravings, which can help increase the likelihood that a person will remain in treatment long enough to achieve recovery.
After the withdrawal phase, physicians generally move patients to a maintenance phase. This entails staying on a steady dose of Suboxone until a patient has achieved some degree of stability. The maintenance phase can have variable lengths, depending upon the severity of the addiction and the individual needs of the patient. Most people stay in the maintenance phase until their addiction treatment program has been completed, though people can safely remain on Suboxone under careful supervision for years.
When physicians and addiction treatment professionals deem it safe, they will generally guide a patient along the process of reducing their dosage. This process, known as tapering, is conducted gradually to prevent the return of excruciating suboxone withdrawal symptoms. At the end of the tapering phase, however, patients emerge entirely opioid-free.
It is important to emphasize, however, that Suboxone alone does not cure opioid addiction. When doctors prescribe Suboxone, they do so in the context of a medication-assisted treatment (MAT) plan that includes other treatment elements, including psychotherapy, group therapy, and support groups. While Suboxone can be used to escape from opioid dependence, opioid addiction is generally far more complicated.
When opioid dependence is treated without addressing the underlying reasons that drove people to become addicts in the first place, relapse is highly likely. Nonetheless, reducing withdrawal symptoms by taking Suboxone can make it easier for patients to engage in other therapeutic modalities, such as psychotherapy. As such, Suboxone should be understood first and foremost as a tool for helping patients become more receptive to treatment more generally.
How is Suboxone Abused?
Suboxone does not offer the same sedating and euphoric effects of commonly abused recreational opioids. It is for that reason that it is effectively utilized as a medication for treating opioid dependence. Because it is difficult to get high from taking Suboxone, it is rarely sought after as a recreational drug.
Nonetheless, a thriving black market for Suboxone does in fact exist. Law enforcement officials regularly confiscate doses of Suboxone that are being sold on the streets. When people buy illegal Suboxone, they are generally doing so not to get high, but to achieve relief from painful symptoms of opioid withdrawal. They are seeking relief through self-medication.
Unfortunately, self-medicating using illegal Suboxone is dangerous and potentially life-threatening. When people abuse Suboxone, they generally take it whenever withdrawal feelings are overwhelming. Using Suboxone impulsively without medical supervision or guidance can result in dangerous dosing practices. It is important to remember that even though Suboxone can be a helpful medication, it is still an opioid — and therefore dangerous. Failing to follow the directions of a prescription can lead to a potentially life-threatening overdose.
There are some people who try to get high off of Suboxone. The most common method people use is altering the medication to make it suitable for injection. While it is possible to inject Suboxone, the naloxone component becomes far more psychoactive when the medication is injected. Injecting naloxone will not result in the high that recreational users seek. In fact, the opposite is true.
The primary effect of naloxone is reversing an opioid high and sending a person into immediate withdrawal. Abusing Suboxone in this case is likely to result in excruciating mental and physical symptoms. Unsupervised and abrupt opioid withdrawal can in fact be dangerous, especially for people who suffer from other comorbid health conditions.
Who is Most Likely to Abuse and Become Addicted to Suboxone?
Suboxone can be abused by people holding prescriptions and by people who buy it illicitly as well. However, the individuals most likely to abuse and become addicted to Suboxone are people who suffer from substance use disorders. These individuals may not have access to other opioids.
As a result, they may try to abuse Suboxone to achieve relief from the symptoms of withdrawal. There are many side effects of Suboxone abuse. Individuals who suffer from addiction often understand the dangers of Suboxone abuse but are unable to control their behavior without outside help. Factors that make a person more likely to suffer from a substance use disorder include:
- A history of addiction in the family. Individuals whose parents abused illicit drugs have a 45% to to 79% increased risk of developing substance use disorders themselves. Addiction has a genetic component, but early exposure through the examples of family members can further entrench a person in addiction. The behavior of addicted family members can also lead to a traumatic and unpredictable upbringing, which can drive people to illicit substances as a way of achieving temporary relief and calm.
- Trauma. Suffering from trauma, especially during early childhood, is correlated with higher rates of substance use disorder. Individuals who suffer from post-traumatic stress disorder (PTSD) are particularly vulnerable.
- Mental health conditions. Aside from PTSD, other mental illnesses like depression, anxiety, bipolar disorder, and schizophrenia increase the likelihood that a person will abuse drugs and develop a dependence on them. This is because substance abuse for many people begins as a form of self-medication. Illicit drugs like opioids can provide relief for many of the symptoms of mental illness, though drug abuse tends to worsen these symptoms over time.
- Chronic pain. The majority of opioid addictions actually begin when a person is prescribed opioids to treat legitimate problems. Individuals who suffer from chronic or severe pain are the most likely to be prescribed opioids. Some people misuse or abuse the medications, but even those who use them as prescribed are at a high risk of developing a dependence. Over time, many turn to heroin or to higher potency synthetic opioids, such as fentanyl.
- Poverty and lack of resources. Suffering from poverty, especially early on in life, is highly correlated with increased substance abuse patterns. Individuals who suffer from poverty are also less likely to have access to proper addiction treatment facilities and resource centers.
- Limited social support system. Individuals with smaller friend groups and social support systems are more likely to turn to drug abuse. Having a stronger social support system also improves addiction treatment outcomes. Unfortunately, drug addiction tends to drive people into further isolation, which results in a vicious cycle that exacerbates drug addiction.
While the above factors make it more likely that a person will suffer from addiction, many people with substance use disorders use Suboxone as prescribed to treat their addiction. Ultimately, the most important factor that determines whether a person will use Suboxone as prescribed is their level of involvement in a treatment program. Having access to addiction professionals, medical supervision, and a strong sober social support system is the best way to ensure that Suboxone is used effectively. More importantly, it is the most effective way of getting sober and maintaining sobriety.
What are the Signs of Suboxone Abuse and Withdrawal?
Suboxone abuse can come in two forms. When people abuse Suboxone in order to obtain relief from the symptoms of opioid withdrawal, they may take too much or take it too frequently. However, when people inject Suboxone with the aim of getting high, they may go into immediate withdrawal due to the naloxone content. These two forms of abuse have dramatically different symptoms.
Abusing or misusing Suboxone at incorrect dosages can present a range of side effects that are common to many opioids. These side effects of Suboxone abuse include:
- Muscle pain
While most of these symptoms are not life-threatening, taking high doses of Suboxone can result in an opioid overdose. When Suboxone is used in combination with other drugs, such as other opioids, alcohol, or benzodiazepines, the risk of a fatal overdose increases exponentially. Signs and side effects of Suboxone overdose include:
- Blurred vision
- Constricted pupils
- Loss of coordination
- Gastrointestinal distress, including vomiting, nausea, and stomach pain
- Loss of consciousness
- Heavy sweating
- Slurred speech
Individuals who inject Suboxone are likely to go into immediate withdrawal due to the naloxone content. However, Suboxone withdrawal is also a natural part of the weaning off process when people use the drug as part of a supervised medication-assisted treatment (MAT) program.
However, without proper supervision from a physician, the Suboxone withdrawal process can pose numerous health complications. The anguish associated with withdrawal can also lead people to relapse and turn to other opioids, which can result in overdose. Withdrawal is therefore not only an arduous process, it is potentially fatal.
Symptoms of Suboxone withdrawal include but are not limited to:
- Gastrointestinal problems, such as diarrhea, vomiting, and abdominal cramps
- Muscle and bone pain
- Cold flashes and goosebumps
- Muscle spasms and uncontrollable leg movements
- Runny nose
- Constricted pupils
- Sleep problems, ranging from insomnia to oversleeping
- Fluctuating blood pressure
- Severe cravings
Most of the symptoms of Suboxone withdrawal begin within 24 hours of quitting Suboxone and gradually wane after several weeks. Ironically, many of these symptoms are the very symptoms that Suboxone therapy is designed to treat. However, rapid and unplanned withdrawal from Suboxone results in these selfsame symptoms.
By taking Suboxone as prescribed and weaning off slowly under careful medical supervision, the severity of Suboxone withdrawal symptoms can be significantly reduced. This is also the best way to ensure that sobriety is maintained in the long run — and that one will never have to experience opioid withdrawal again.
Why is Suboxone so Addictive?
Opioids are addictive because of the direct effect they have on opioid receptors in the brain and throughout the body. When opioids activate opioid receptors, the brain releases high quantities of the neurotransmitter dopamine. Dopamine is sometimes known as the “reward chemical,” because it makes people feel good and plays an essential role in areas of the brain that control motivation and decision-making. Dopamine is responsible for the high that opioid addicts experience when they abuse drugs. It is also responsible for reinforcing the behavior of drug abuse itself. When large amounts of dopamine are released, a person is more likely to repeat the behavior that led to the release. For non-addicts, playing sports or having sex can cause a release of dopamine. However, drug abuse, especially opioid abuse, leads to astronomically high dopamine levels, which can permanently alter the brain’s ability to say no to drugs.
As patterns of opioid abuse set in, the brain adapts to opioids by creating more opioid receptors and becoming desensitized to the effects. If a recreational drug user wishes to get high, they must take larger and larger quantities of opioids. At the same time, when the body acclimates to the presence of opioids, it begins to react violently when opioids are depleted. This reaction, known as withdrawal, is both physically and mentally painful, and most people will stop at nothing to avoid experiencing it.
When people reach the point where desensitization and tolerance require them to take high doses and withdrawal causes them to avoid quitting, they have become physically dependent. Not everyone who is physically dependent suffers from addiction, but when people find themselves unable to stop taking opioids despite negative consequences and a desire to quit, they can be said to suffer from a substance use disorder.
Suboxone, despite not offering the same intoxicating euphoria as other opioids, is addictive precisely because of the relief it offers. People withdrawing from opioids might be tempted to abuse Suboxone due to fears they may have about withdrawal symptoms.
Even people in addiction treatment programs and taking Suboxone as prescribed may be reluctant to wean off the drug and experience sobriety without the crutch of medication. Suboxone addiction is relatively rare, since most people trying to get high turn to other opioids, but many people do get trapped in a cycle of “quitting” recreational opioids but never quite weaning off Suboxone.
How is Suboxone Addiction Treated?
Suboxone addiction, like other opioid addictions, is not easy to fight off on ones own. Many cultures stigmatize addiction to a considerable extent, spreading messages that people who abuse drugs like Suboxone simply need to exert more willpower. Addicts are told continually — and often tell themselves — that they are weak and need to be stronger.
Many people may be in denial about their own addictions as well. The mass media often depicts addiction in a stereotyped way, causing people to believe that unless they’ve lost everything, there’s no way they can be addicts. The reality is that addiction can affect anyone, the most destitute to the most affluent. It is also a very real condition that has nothing to do with personal character or strength of will. Just as a broken leg requires a cast and can’t be expected to merely heal on its own through sheer willpower, addiction requires outside help.
If you or a loved one suffers from Suboxone addiction, it is best to reach out to a treatment center. Outpatient addiction programs can provide individuals with the support they need during the difficult process of detoxing from Suboxone. By detoxing in a trigger-free environment under medical supervision, they can ensure that the process is smooth, safe, and healthy.
Further, outpatient addiction treatment programs offer individuals tools they need to stay sober over the long run. Addiction is not a condition that disappears as soon as a person is off drugs. Rather, the condition needs to be continually managed if long term sobriety is the goal. To that end, addiction treatment programs offer psychotherapy, group therapy, access to support groups, and skills-building workshops.
Outpatient Treatment Programs in Los Angeles
Outpatient addiction programs are fundamentally about providing individuals with the tools they need to avoid relapse — and moreover, with the tools they need to rebuild happy and prosperous lives in sobriety.
No matter how difficult your addiction is, no matter how hopeless your life seems, recovery is possible. Reach out today for help.