Suboxone Treatment for Opioid Dependence

Suboxone is the most commonly used brand-name formulation of buprenorphine and naloxone. Learn about the role of Suboxone in treating opioid addiction.

Suboxone is a medication option used to treat the withdrawal symptoms and drug cravings that occur during detox and early recovery from opioid use disorder (OUD). Suboxone is used in medically assisted detox (MAT) and treatment, and the drug can be an effective option for some people.

As with other medications used in MAT, Suboxone is not a stand-alone treatment for addiction. The use of drugs such as Suboxone is a part of an overall comprehensive treatment program for opioid addiction.

What Is Suboxone?

Suboxone is a brand-name formulation of buprenorphine and naloxone in a 4:1 ratio. The drug comes as a pill or sublingual strip that is dissolved under the tongue. Suboxone is the most common formulation of buprenorphine and naloxone in use for OUD.

Buprenorphine is a long-acting, partial opioid agonist drug. It has a particularly high affinity for opioid receptors in the brain. If those terms sound confusing, here is exactly what they mean and why they make this component of Suboxone so useful for treating OUD:

• Long-acting: It stabilizes opioid receptors, preventing withdrawal and cravings. In addition, it can be dosed every other day or twice weekly.
• High affinity for opioid receptors: It attaches strongly, pushing other opioids out of the way and blocking other opioids from attaching to receptors. This helps prevent misuse of Suboxone or other opioids.
• Partial opioid agonist: It has very little opioid activity, so it causes very little “high” and has low overdose risk.
• Ceiling effect: Buprenorphine has a ceiling effect, which means its negative effects max out and don’t increase with further use

Naloxone — the other active ingredient in Suboxone — is an opioid blocker (opioid antagonist). It prevents attempts at misusing buprenorphine or other opioids by blocking their effects.

History of Suboxone

Buprenorphine, the opioid in Suboxone, was first synthesized in the 1970s as a less addictive pain medication. Researchers soon found buprenorphine has three properties that make it particularly well suited for opioid replacement therapy in treating opioid addiction:

1. It has an unusually long half-life
2. It is only a partial agonist
3. It displaces other opioids from their receptors

In 2000, the Drug Addiction Treatment Act was amended to allow community physicians to prescribe the drug, making it much more accessible. Suboxone was created as a mix of buprenorphine with naltrexone. It received FDA approval in 2002, with generic versions being approved in 2018.

How Long Does Suboxone Stay in Your System?

How long does it take for Suboxone to kick in? Buprenorphine — the ingredient in Suboxone that relieves withdrawal symptoms — takes three to four hours to reach peak levels in the blood and to have its maximal effect.

How long does Suboxone last? The two active ingredients in Suboxone have different half-lives:

• Buprenorphine: 16.4 to 27.5 hours
• Naloxone: 1.9 to 2.4 hours

Buprenorphine is a much stronger binder to opioid receptors than naloxone, so it determines how long Suboxone’s duration of action lasts. It takes three to five days from the last dose until buprenorphine levels drop low enough to start causing withdrawal symptoms.

Why Use Suboxone?

Taking Suboxone can make all the difference for some people, especially those who are fearful of withdrawal or unable to endure withdrawal without relapse. It’s effective at reducing cravings and discouraging misuse, and it can help people through their early recovery while they undergo treatment.

People who use prescription opioids as directed are still likely to have withdrawal symptoms. Their physician will usually place them on a tapering dose of their opioid, but Suboxone may be used if they cannot follow the prescribed taper.

Suboxone vs. Methadone

Suboxone is at least as effective as methadone but is likely more effective. It has several advantages over methadone:

• Better tolerability, so people are more likely to remain on it
• Can be dosed less frequently (every other day versus daily for methadone)
• It has lower misuse potential
• Suboxone can be reduced and tapered off more rapidly

However, Suboxone is much more costly than methadone.

Subutex vs. Suboxone

Subutex differs from Suboxone in that it does not contain naltrexone. As such, Subutex is the better choice for use in pregnant women or women who may become pregnant.

Zubsolv vs. Suboxone

Zubsolv is similar to Suboxone but is only available in a sublingual tablet.

Vivitrol vs. Suboxone

Vivitrol is an extended-release injectable naltrexone formulation that does not contain buprenorphine. It is often used as a step-down therapy for people after they discontinue Suboxone.

Suboxone Side Effects

Some of the common side effects of Suboxone include:

• Dependence or addiction
• Headache
• Low energy, lethargy, and fatigue
• Sweating
• Constipation
• Drowsiness
• Low blood pressure

People should not operate machinery or drive until they see how Suboxone affects them. Other serious side effects of Suboxone include:

• Suboxone Withdrawal: People who are discontinuing Suboxone can expect some withdrawal symptoms typical of opioids. Symptoms begin three to five days after the last dose and continue for about 14 days. These can be minimized by a slow taper off the drug and medical assistance in treating any withdrawal symptoms.
• Precipitated Withdrawal Suboxone: Both active ingredients of Suboxone will displace other opioids from their receptors in the brain. As such, Suboxone-precipitated withdrawal may occur if the drug is started too early after the last use of opioids.
• Suboxone Overdose: The pharmacological properties of Suboxone make overdose an unlikely event. However, there are some situations where Suboxone overdose is more likely to occur:
• When people who have not been heavy users of opioids try using the drug
• When people try injecting the drug
• When people try to relapse by taking large doses of opioids in an attempt to overcome Suboxone’s blocking effects

Suboxone overdose symptoms include:

• Pinpoint pupils
• Sedation, loss of consciousness or coma
• Low blood pressure
• Respiratory depression (slow, shallow or stopped)
• Death

Suboxone Drug Interactions

There are 592 drugs that are known to have adverse drug interactions with Suboxone, including 177 major interactions and 409 moderate interactions. It is important for people considering Suboxone therapy to give prescribers an accurate list of all their regular or occasional medications. These include prescription drugs, over-the-counter medicines, herbal remedies and drugs of misuse (including alcohol).

Who Should Take Suboxone?

According to the Suboxone prescribing information provided by the FDA, Suboxone should be used for the treatment of OUD in adults over the age of 18. Suboxone is intended for use as part of a comprehensive opioid addiction treatment regimen. It should not be regarded as a stand-alone therapy.

Because of its flexibility to be used in outpatient and office-based settings, Suboxone is an especially useful option for people who are receiving outpatient treatment or have been discharged from a residential or inpatient rehab program.

Related Topic: Opioid Addiction Treatment

Who Should Avoid Suboxone?

Though some drugs with buprenorphine are used for pain relief, Suboxone should only be used for the treatment of OUD. Mixing Suboxone with benzodiazepines or other central nervous system depressants, including alcohol, can have serious or even fatal consequences.

There are other cases where Suboxone should be avoided:

• People with impaired liver function should not take Suboxone unless told to by their physician.
• Suboxone should not be used during pregnancy or by women who may become pregnant. It should not be used by women who are breastfeeding.
• Suboxone should not be used by children.

Where Is Suboxone Prescribed?

Suboxone is available as part of a comprehensive treatment plan for OUD in a variety of settings. These include:

• Detox centers: Short-term Suboxone use for opioid withdrawal is usually offered at any detox center that offers MAT. Detox facilities have staff who are experts in how to use Suboxone for opioid withdrawal.
• Treatment centers: Suboxone is widely used by outpatient, residential and inpatient treatment centers that offer MAT.
• Private Suboxone doctors: One of the advantages of buprenorphine is that it offers the option of office-based MAT of opioid use disorder. Doctors who prescribe Suboxone must be specially licensed to prescribe buprenorphine. If they prescribe Suboxone from their office, they should be experienced in treating addictions.

Success Rate of Suboxone Treatment

Most studies have been done on buprenorphine or naloxone and not on specific pharmaceutical products, such as Suboxone. However, quality studies have shown that buprenorphine is highly effective in the right individuals. Its use has been associated with:

• Reduced mortality
• Reduced relapse rates
• Reduced HIV and hepatitis C transmission rates
• Improved outcomes in pregnancy
• Improved retention within recovery programs
• Improved quality of life

Further, Suboxone’s combination of buprenorphine and naloxone has been shown to offer the same benefits as buprenorphine alone. However, it also has the added benefit of further reducing misuse potential or relapse.