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Suboxone Use and Abuse

Suboxone is a combination of buprenorphine and naloxone. This medication is used to treat dependence on opioid drugs.

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Suboxone is known to help people who struggle with addiction to heroin or prescription painkillers. While some people fear that Suboxone is a drug of abuse, it is not commonly abused due to its abuse-deterrent properties.

When used under physician supervision, it can be an effective form of treatment for opioid addiction.

Suboxone: An Overview

Suboxone is a controlled medication that can only be used with a prescription. It does have abuse potential, though it is not commonly abused due to its naloxone component.

If used as directed and under medical supervision, Suboxone is known to be safe for up to 24 weeks.
  • Naloxone was created to quickly stop an overdose, per the National Institute on Drug Abuse (NIDA). It is designed to react to the same chemical messengers as opioids, but it has the opposite effect as narcotic drugs. If you experience an overdose, naloxone works to stop the harmful effects of opioids. It can help you breathe again if you start having respiratory issues, and it stops opioids from working overall.
  • Buprenorphine affects the same neurotransmitters that interact with opioids, but it acts much more slowly and reduces cravings for drugs. Phamacy Times reports that buprenorphine is approved for cases of moderate to severe pain and to help people who are recovering from addiction to an opioid.

Suboxone has been approved for use as a film. It can either be placed between the cheek and gums (buccal) or under the tongue (sublingual).

Formulations are available at these amounts:

Buprenorphine Naloxone
2 mg 0.5 mg
4 mg 1 mg
8 mg 2 mg
12 mg 3 mg

Who Uses Suboxone?

We need more demographic data to understand how Suboxone use differs by age, race, or gender. As of now, the Substance Abuse and Mental Health Services Administration (SAMHSA) offers data on opioid treatment programs (OTPs) that offer the medication as part of their services.

  • More OTPs offer buprenorphine now. In 2003, only 11 percent offered it; in 2015, 58 percent did.
  • Other facilities that aren’t OTPs have also started offering buprenorphine more. In 2003, only 5 percent offered it; in 2015, 21 percent did.

Risks of Using Suboxone

Like any medication, there are possible side effects and risks of using Suboxone.

The Food and Drug Administration (FDA) warns that you should stay away from alcohol or other depressants, such as benzodiazepines, when taking Suboxone. The combination could cause blackouts or even be fatal.

Also, do not drive or operate machinery until you are aware of how Suboxone affects you. Drowsiness can cause you to become slower and more prone to accidents.

The FDA lists several potential side effects of Suboxone:
  • Dizziness and issues with coordination
  • Low blood pressure
  • Problems with respiration
  • Allergic reactions to the medication, such as hives, wheezing, decreased blood pressure, and coma
  • Symptoms of opioid withdrawal, such as shaking, runny nose, diarrhea, vomiting, muscle cramps, and changes in temperature
  • Misuse of the medication

People with liver issues should avoid Suboxone, as it could cause health issues, such as vomiting, nausea. It could also cause fluids to build up in the legs.

What Suboxone Treatment Is Like

Buprenorphine is often used to treat opioid addiction, but it can be habit-forming. While buprenorphine does not cause euphoria in standard doses, it can be abused in an effort to achieve that euphoria.

Suboxone is known to be less addictive because naloxone prevents the buprenorphine from triggering a high if the drug is abused.
When Suboxone is used, the following steps are taken:
  • Step 1: Evaluation
    Your drug and medical history is taken, and you are asked questions about your mental health. Intake includes urine and blood tests, as well as a drug screening. This helps physicians know if your body can handle Suboxone.
  • Step 2: Induction
    This is when you start taking Suboxone to substitute whatever you took before. Induction is meant to decrease the possibility of experience uncomfortable feelings of withdrawal.
  • Step 3: Adjustment
    At this point, your physician will give you the lowest dose of Suboxone possible to stave off cravings and decrease the likelihood of feeling symptoms of withdrawal. They will start the tapering process so you can live a drug-free life.
  • Step 4: Maintenance
    Aftercare is needed once you stop taking Suboxone. You will continue with therapy, support groups, and taking medications, as needed.

Signs of Possible Misuse

Buprenorphine is frequently used on its own to successfully treat people with opioid use disorder. A 2014 study published by the Journal of Addiction Medicine found that increased availability to this medication has raised concerns about potential misuse and diversion.

Th study explains that misuse of buprenorphine starts out with what is called medical nonadherence

Instead of following directions, people may use the medication in ways it is not intended to be used. They may:
  • Inject Suboxone instead of taking it by mouth. Illicit injection of Suboxone could increase the odds of exposure to diseases such as hepatitis C and HIV.
  • Divert the drug. People may obtain the medication illicitly or use someone else’s legal prescription.
  • Snort Suboxone. This can also cause stress in your nose and eventually cause respiratory issues. Generally, snorting Suboxone is not an effective way to abuse it since naloxone is activated when the drug is crushed.
  • Increase the dosage without a physician’s direction or approval, which could increase the likelihood of overdose.

The Journal of Addiction Medicine goes on to mention that any time you use your prescription in a way that you have instructed not to, you are misusing the drug. People are much more likely to misuse buprenorphine on its own.

Again, the presence of naloxone discourages misuse of Suboxone.
Mayo Clinic outlines other signs of misuse that could be applicable to someone who abuses Suboxone:
  • Craving for drugs that overshadows other thoughts
  • Feeling that you must use the drug
  • Taking more of the drug than intended
  • Changing your social or recreational habits to use drugs, or failing to meet responsibilities because of drug use
  • Inability to quit using even with your best efforts
  • Experiencing symptoms of withdrawal if you have not used the drug in a while

Intervention in Cases of Suboxone Misuse

Per the Journal of Addiction Medicine, there are some steps doctors can take to prevent misuse of Suboxone:

  • Explain what diversion is. Patients should know how to properly use Suboxone, and doctors can identify triggers that can help their patients avoid misuse altogether.
  • Monitor patients. This can include checking their nasal passages during consultations, documenting missed appointments, giving urine tests, and discussing any observations with patients.
  • Work with family members, pharmacists, and other experts who have insight on changes in the patient’s behavior.

Experts can also refer people to treatment facilities that can provide a tailored tapering plan for Suboxone, as well as counseling and other support if it is misused.

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