Seeking treatment for any addiction takes tremendous courage. Addiction to opiates is a national crisis, and a crisis for any family. Suboxone (buprenorphine/naloxone) treatment is thought to be the most effective available option for opiate use disorders. So, what do you need to know about suboxone and suboxone treatment to decide if it’s right for you or your loved one?
What is Suboxone?
Suboxone is a medication used help people reduce or quit their use of heroin or other opiates, such as pain relievers like morphine or oxycontin. It is prescribed in the context of what is called medication assisted treatment (MAT) which is an outpatient treatment, delivered in a specially qualified physician’s office. Initially, taking buprenorphine will help reduce withdrawal and withdrawal symptoms from other opiates, such as heroin, oxycodone, or morphine. Later in your treatment, it will be used to help you from returning to using other opiates and maintaining your health and sobriety.
Suboxone contains the opiate medication buprenorphine, and an opiate blocker, naloxone. Naloxone is inactive when taken orally.
Unlike methadone treatment, which must be performed in a highly structured clinic, buprenorphine is the first medication to treat opioid dependency that is permitted to be prescribed or dispensed in physician offices, significantly increasing treatment access.
Buprenorphine offers several benefits to those with opioid dependency and to others for whom treatment in a methadone clinic is not preferred or is less convenient.
How Suboxone Works
Buprenorphine has unique pharmacological properties that help:
- Lower the potential for misuse
- Diminish the effects of physical dependency to opioids, such as withdrawal symptoms and cravings
- Increase safety in cases of overdose
- Buprenorphine is an opioid partial agonist. This means that, like opioids, it produces effects such as euphoria or respiratory depression. With buprenorphine, however, these effects are weaker than those of full drugs such as heroin and methadone. Buprenorphine’s opioid effects increase with each dose until at moderate doses they level off, even with further dose increases. This “ceiling effect” lowers the risk of misuse, dependency, and side effects.
Additional advantages of burpenorphine include reduced need for constant daily opiate seeking, allowing patients to re-engage in daily life including paid work and enjoyment of family. Buprenorphine, when used in a MAT, also reduces the need to engage in high risk behaviors including IV drug abuse, criminal activity, and incarceration.
Suboxone, like other opiates, can be misused, but misuse potential is limited by the addition of naloxone, which is completely inactive when the medication is taken orally, but causes opiate withdrawal if injected. The “ceiling” effect also limits misuse, but of course, cannot prevent all misuse.
What is Treatment with Suboxone Like?
Buprenorphine treatment happens in three phases:
- The Induction Phase is the medically monitored startup of buprenorphine treatment performed in a qualified physician’s office. The medication is administered when a person with an opioid dependency has abstained from using opioids for 12 to 24 hours and is in the early stages of opioid withdrawal. It is important to note that buprenorphine can bring on acute withdrawal for patients who are not in the early stages of withdrawal and who have other opioids in their bloodstream.
- The Stabilization Phase begins after a patient has discontinued or greatly reduced their misuse of the problem drug, no longer has cravings, and experiences few, if any, side effects. The buprenorphine dose may need to be adjusted during this phase.
- The Maintenance Phase occurs when a patient is doing well on a steady dose of buprenorphine. The length of time of the maintenance phase is tailored to each patient and could be indefinite. Work closely with a well qualified doctor to determine the length of time you will need in maintenance phase.
How Does Medication Assisted Treatment Work?
In 2013, an estimated 1.8 million people had an opioid use disorder related to prescription pain relievers, and about 517,000 had an opioid use disorder related to heroin use. MAT has proved to be clinically effective and to significantly reduce the need for inpatient detoxification services for these individuals. MAT provides a more comprehensive, individually tailored program of medication and behavioral therapy. MAT also includes support services that address the needs of most patients.
The ultimate goal of MAT is full recovery, including the ability to live a self-directed life. This treatment approach has been shown to:
- Improve patient survival
- Increase retention in treatment
- Decrease illicit opiate use and other criminal activity among people with substance use disorders
- Increase patients’ ability to gain and maintain employment
- Improve birth outcomes among women who have substance use disorders and are pregnant — please note preganant patients will have special considerations
- Research also shows that these medications and therapies can contribute to lowering a person’s risk of contracting HIV or hepatitis C by reducing the potential for relapse.
How will Suboxone Help My Psychotherapy
Psychotherapy for addiction will include components of education, gaining understanding triggers and developing plans for your high risk times, a focus on the behavioral aspects of opioid addiction, and gaining a deeper understanding of your personal reasons vulnerabilities to addiction. Cooexisting illnesses, like depression or PTSD may be diagnosed and treatment undertaken. Psychotherapy will be tailored to each patient’s specific need. Taking suboxone can allow you to regain a normal state of mind – free of withdrawal, cravings and the drug-induced highs and lows of addiction, such that you can fully participate in your psychotherapy and begin your recovery successfully.
Defeating an addiction requires both physical and mental adaptations to your surroundings. During psychotherapy, you will learn what triggers your cravings and desire for opioids and how to work around them without relapsing. You’ll learn different coping mechanisms to help you battle rough patches without relapsing. You’ll learn just how strong you really are and you’ll be armed with the proper tools to help you remain opioid-free even after Suboxone is no longer used in your treatment.
Addiction treatment has made great strides throughout the years. If you or a loved one is struggling with an opiate addiction, take the next step and talk to a qualified physician about available treatment. It’s crucial to seek the proper treatment.
Dr. Amanda Itzkoff
My name is Amanda Itzkoff, MD. I am a New York City based Psychiatrist and Assistant Professor at Mount Sinai Medical Center.
For additional information, please feel free to email our office at Amanda.Itzkoff@gmail.com.
To schedule an appointment, call our offices at 917-609-4990.