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Anti-Addiction Medications – Suboxone

Drug and alcohol addiction is a chronic disease that begins in the brain, which is why Enterhealth Ranch and Enterhealth Outpatient Center of Excellence utilize FDA-approved anti-addiction medicines as an integral part of a comprehensive treatment plan that’s unique to each patient. Anti-addiction medications like suboxone have been shown to help with the unpleasant withdrawal symptoms and stop the cravings, allowing patients to focus on recovery and healing.

What is Suboxone?

Suboxone is the brand name for the combination of two drugs: Buprenorphine and Naloxone. Buprenorphine is a partial opioid agonist, meaning it activates the body’s opioid receptors much like any other opioid substance, but because it is very weak, it doesn’t cause the same euphoria (high) as before.

The naloxone component helps reverse the effects of opioids so that the they can’t produce the euphoria (or high) normally associated with opioid use. This prevents patients from abusing the suboxone itself, and it deters them from relapsing because they will not be able to achieve a high from any opioid drug while the naloxone is in their system.

When used in tandem, these two medications help patients by preventing the unpleasant physical withdrawal symptoms of opioid addiction and allowing them to participate fully in therapy for the psychological aspects of their addiction. When used within a comprehensive addiction treatment program, suboxone often makes the patient feel quite “normal” for the first time in many years. This internal emotional stability allows the patient to focus on recovery rather than relapse and makes it easier for them to understand the necessity of their rehabilitation.

How does Suboxone treatment work?

Treatment for opioid dependence occurs in three phases: induction, maintenance, and tapering. Suboxone is used in each of these phases, with the dose only being slowly tapered down when the patient is deemed to be emotionally and physically stable.

Induction

The induction, or “acute,” phase starts as soon any opioid drugs have left the body – typically around 12 to 18 hours after the last time the person used the substance. Depending on variables such as drug use history, age and weight, the doctor at Enterhealth will prescribe the initial dose of suboxone, which may be gradually raised it until the withdrawal symptoms are satisfactorily under control.

During the induction phase, Suboxone is used to reduce withdrawal symptoms when opioid use is being decreased or stopped. Suboxone is only used for induction in people who are dependent on short-acting opioids, which includes things like include heroin, codeine, morphine, and oxycodone, as these drugs leave the body relatively quickly.

Use of suboxone should only begin when the effects of these opioids have safely worn off and withdrawal symptoms have begun. This allows the withdrawal symptoms to come on gradually. If suboxone is administered too early, it can induce what is called precipitated withdrawal, which occurs quickly and can be quite intense.

Maintenance

During the maintenance phase, suboxone is administered at a stable dosage for an extended period of time. The purpose of the maintenance phase is to reduce cravings and other symptoms of withdrawal so that patients are able to fully participate in a comprehensive addiction treatment program.

Tapering

Studies have shown that longer treatment times lead to better outcomes, which is why drugs like suboxone are becoming widely used for the treatment of opioid addiction. Studies show that up to 49 percent of participants are able to successfully reduce their opioid use during Suboxone treatment.

Usually after a period of several months to a year or longer, your physician will gradually reduce your suboxone dosage, being careful to avoid the onset of withdrawal symptoms as much as possible. The longer the tapering phase, the better.

How to take Suboxone

Suboxone is typically formulated as either a film or tablet meant to be taken sublingually (dissolved under the tongue). Use dry hands when handling Suboxone. Place the sublingual tablet or film under your tongue and allow the medicine to dissolve slowly. Do not chew or swallow it whole.

Injecting or snorting suboxone may lead to a life-threatening sudden onset of withdrawal (sudden, serious, withdrawal symptoms such as pain, cramps, vomiting and diarrhea) in people who are physically dependent on other opioids.

Suboxone should only be used as directed by your doctor, and it’s important to follow all directions on your prescription label and read all medication guides. In a clinical setting, Suboxone is often administered under supervision to ensure that the patient takes the medication as directed and to prevent misuse.

What Should You Do If You Miss a Dose of Suboxone?

If you miss your dose, the best thing to do is usually to wait until it’s time for your next dose. If only a short amount of time has passed since you missed your dose you may take it, but it’s important to maintain a regular schedule.

You should never take two doses at the same time, as this does not make up for the dose you missed and may cause overdose or other negative reactions.

What should you do if you overdose on Suboxone?

Suboxone overdose can be fatal, especially in children or in people using this medicine without a prescription.

Symptoms of suboxone overdose are similar to those of other opioid drugs, including:

  • Loss or coordination
  • Drowsiness
  • Slurred speech
  • Difficulty concentrating
  • Reduced heart rate and breathing
  • Unconsciousness
  • Seizures

If you or someone else is experiencing symptoms of suboxone withdrawal, contact a poison control center or emergency room as soon as possible.

What Are Side Effects of Suboxone?

Suboxone can cause mild or serious side effects. The following list contains some of the key side effects that may occur while taking Suboxone. This list does not include all possible side effects.

The more common side effects of Suboxone include:

  • Dizziness
  • Headaches
  • Drowsiness
  • Nausea
  • Depression
  • Decreased sex drive

Serious side effects from suboxone aren’t common, but they can occur. Serious side effects can include the following:

  • Severe allergic reaction
  • Breathing problems
  • Coma
  • Hormone problems (adrenal insufficiency)
  • Liver damage
  • Severe withdrawal symptoms

Some medicines can interact with buprenorphine and naloxone and cause a serious condition called serotonin syndrome. Be sure your doctor knows if you also take stimulant medicine, herbal products, or medicine for depression, mental illness, Parkinson’s disease, migraine headaches, serious infections, or prevention of nausea and vomiting. Ask your doctor before making any changes in how or when you take your medications.

Do not consume alcohol while taking Suboxone, as this may increase the risk of breathing difficulties that can lead to coma and death.

Breathing problems and coma

Taking high doses of suboxone can cause severe breathing problems, coma, and death. These effects are more likely to occur when suboxone is misused or abused. They’re also more likely when suboxone is used together with other drugs such as opioids, alcohol, or benzodiazepines (such as Ativan, Valium, or Xanax).

Breathing problems are also more likely to occur in people who already have a breathing problem, such as chronic obstructive pulmonary disease (COPD), sleep apnea, or an abnormal curvature of the spine that affects your breathing.

Hormone problems

Some people who take opioids such as suboxone for several weeks may experience reduced cortisol hormone levels. This condition is called adrenal insufficiency, and it can lead to symptoms such as:

  • Nausea
  • Vomiting
  • Diarrhea
  • Loss of appetite
  • Fatigue and weakness
  • Dizziness
  • Low blood pressure
  • Depression

Suboxone withdrawal symptoms

In addition to these side effects, the abrupt discontinuation of buprenorphine could also lead to the onset of withdrawal. If a person has been taking suboxone for a long period of time and they no longer receive it, they may be at risk of developing withdrawal symptoms similar to those associated with other opioid drugs.

The severity of symptoms experienced depends on the degree of physical dependence, which itself depends on the dose and duration of use. Common withdrawal symptoms may include:

  • Opioid cravings
  • Anxiety
  • Insomnia
  • Mood swings
  • Abdominal cramps.
  • Nausea, vomiting, and diarrhea
  • Excessive sweating

How long does suboxone stay in your system?

The buprenorphine in Suboxone has an especially long elimination half-life compared to other opioids. Elimination half-life refers to the amount of time it takes for half of a single dose of a drug to leave the body. For buprenorphine, this period lasts for 37 hours, meaning that it can take over 8 days for Suboxone to no longer be detectable in a person’s body.

This period of time is not the same for everyone. There are a number of factors that influence how quickly Suboxone will be flushed out of the system. These include:

  • Body fat content
  • Weight and height
  • Age
  • Metabolism speed
  • Size of the last dose taken
  • Amount of time the abuse has gone on
  • Liver health

How long should you take suboxone?

Doctors will generally start lowering your dose of dose of Suboxone once you start feeling normal and balanced. Generally, you can stay on Suboxone for lengthy periods of time without suffering from too many negative side effects.

However, you should start tapering off your dosage if you fit the following criteria:

  • You are over 30
  • Your confidence is higher
  • Employment has become stable and consistent
  • An emotional support system has been put into place for you
  • Cravings have become almost absent

As addiction treatment is so individualized, there’s no generally accepted timeline for tapering off drugs like suboxone. Some people may only need it a few months, while others may require it for a year or more.

Is Suboxone a controlled substance?

Yes, Suboxone is a controlled substance. It’s classified as a Schedule III prescription drug. This means that it has an accepted medical use, but it may cause physical or psychological dependence and may be abused if taken improperly or without a prescription.

In addition, the federal government has put into place special rules for how schedule III drugs can be prescribed by a doctor and dispensed by a pharmacist. Doctors can only prescribe this drug for opioid dependence after receiving special training and certification through the U.S. federal government.

Suboxone Alternatives

Methadone

Methadone has been used to treat opioid addiction since the 1960s, and like Suboxone, it’s a synthetic opiate agonist. This means that it stimulates the areas of the brain affected by opiate addiction. It is generally taken once every 24 to 36 hours and helps eliminate physical withdrawal symptoms while also helping to stop cravings for unsafe opiates, such as heroin and morphine.

One of the major pros of methadone is its well-studied nature. It has been used for more than 30 years and has been studied and tested multiple times during that duration. This means scientists understand the way it affects the body more thoroughly than they do suboxone. As a result, it’s easier for them to find a healthy and safe dose quickly and without much experimentation.

However, one of the major problems with methadone is that it’s possible to continue using other opioids while taking it. Unfortunately, this makes it harder for people with severe addictions to recover successfully.

People struggling with opioid addiction have noted that the two-pronged approach of suboxone is a great way to detoxify the body. The buprenorphine ensures that they don’t feel the kind of physical and emotional distress that makes withdrawal and recovery so difficult, and the naloxone makes it more difficult or impossible to use other opioids at the same time, making relapse less likely.

Suboxone also works on a quicker time scale than methadone, and it can be administered in both an inpatient and outpatient setting. Those prescribed are usually able to take their prescription home with them, and continue a normal schedule with work, school, and regular activities as they continue on suboxone until they’re able to manage their life in recovery without it.

Methadone, on the other hand, is still usually used in a clinical setting, with patients needing to visit a clinic daily to get their dose. This can interfere with many responsibilities in life and can make returning to regular activity, such as work, much more difficult.

Vivitrol

Another evidence-based medication for opioid use disorder is Vivitrol (extended-release naltrexone), an opioid antagonist formulated as a once-a-month injection. This medication is delivered once every 4 weeks instead of every day, which might help address concerns about needing to take a daily medication, as well as the potential problems that could arise if someone is also taking other drugs like alcohol, benzodiazepines, and others.

The downside to Vivitrol is that it only acts to prevent relapse, it doesn’t alleviate the symptoms of withdrawal. This means that the patient needs to have stopped using opioid medications for between 7-10 days before they can be treated with Vivitrol, and it makes participation in therapy and other elements of recovery more difficult.

 

At Enterhealth, we offer medically supervised opioid treatment programs for qualified patients at our inpatient rehab facility, Enterhealth Ranch, and through The Enterhealth Outpatient Center of Excellence. These programs offer patients a comfortable and safe detox from opioids using anti-addiction medications like suboxone to reduce cravings and relieve withdrawal symptoms so patients can participate in a comprehensive therapy program that’s been shown to achieve a sustained recovery.

Call Enterhealth at 1-800-388-4601 now and take charge of your recovery. We’re here every day at any time to take your call.

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