Available as a sublingual filmstrip that is dissolved under the tongue, Suboxone is a treatment approved by the US Food and Drug Administration (FDA) for opioid dependence, Suboxone contains both the partial opioid agonist buprenorphine and the opioid antagonist naloxone, the Substance Abuse and Mental Health Services Administration (SAMHSA) reports.
An opioid agonist attaches to opioid receptor sites in the central nervous system and increases levels of dopamine in the brain. Full agonists, like heroin or prescription painkillers (e.g., OxyContin, Vicodin, etc.) cause a mellowing and euphoric “high” when abused. Buprenorphine is a partial agonist, meaning that it doesn’t create quite the same high that full agonists do. It also has what is referred to by Psych Central as a “ceiling effect,” which means that after a certain amount is taken, the drug stops being effective. Thus, taking more of the drug does not necessarily mean that the “high” will be increased.
Suboxone also contains an opioid antagonist drug, naloxone, which has the opposite effect of an agonist and actually serves to block opioid receptors from receiving more opioids. This is supposed to make it abuse-deterrent. The naloxone portion of Suboxone is smaller and typically remains dormant unless the drug is abused via injection. The journal Current Drug Abuse Reviews publishes that in combination opioid dependence products, such as Suboxone, the ratio of buprenorphine to naloxone is four to one.
Why Is Suboxone Used?
Almost 4,000 people try a prescription opioid drug for nonmedical reasons every day in the United States while close to 80 people die from an opioid overdose daily, the US Department of Health and Human Services (HHS) publishes. The American Society for Addiction Medicine (ASAM) reports that nearly 2 million adults in the United States (aged 12 and older) suffer from addiction involving a prescription pain reliever. Suboxone, when used in tandem with counseling, can help to keep people in treatment longer, which often directly translates to a reduction in opioid abuse and increases in sustained recovery, NPR reports.
Suboxone can be prescribed by qualified doctors under the Drug Addiction Treatment Act (DATA) to treat opioid addiction and dependence on a long-term basis, according to one of the makers of the drug, Indivior. Unlike its predecessor methadone, buprenorphine products can be prescribed out of a doctor’s office and picked up at a person’s preferred pharmacy.
Suboxone is still a partial opioid with the potential for abuse, however. At a time when opioid dependence and deaths from opioid overdose are at an all-time high, Suboxone, which may seem like a miracle drug for treating opioid addiction, needs to be closely monitored so it doesn’t add fuel to the fire.
The Drug Enforcement Administration (DEA) uses several measures to indicate drug abuse and diversion, one of them being how often the drug is seized by law enforcement. In 2012, the DEA reported that their laboratories identified buprenorphine in more than 10,000 drug seizures. This means that the prescription-only drug was likely being diverted from licit channels. Another measure of abuse is the Drug Abuse Warning Network, or DAWN, which tracks how many individuals seek emergency department (ED) treatment for nonmedical use of a drug. In 2011, DAWN reported that over 20,000 people sought emergency medical care in an ED for a negative reaction to abuse of a buprenorphine product like Suboxone.
Often called subs, stop signs, oranges, bupe, or saboxine, The New York Times publishes that there is a significant underground market for Suboxone, as individuals may seek it for the “buzz” it creates when used recreationally. While not as intense as a heroin high, its effect can still be mind-altering and desirable for recreational drug users.
It is often found as contraband in the inmate population, as individuals can smuggle the filmstrips into prison taped to pages of books, and it is then abused as “prison heroin,” the National Pain Report publishes. The Washington Post speculates that the majority of those abusing Suboxone are likely battling opioid addiction and using the drug in order to self-medicate the difficult symptoms of opioid withdrawal.
Taking Suboxone without a legitimate and necessary prescription, especially if it is used in combination with other drugs (heroin, prescription painkillers, benzodiazepines, and alcohol in particular) can significantly increase the risk for an overdose. Opioid drugs slow down heart rate, respiration levels, and blood pressure while lowering body temperature. Taking too much of a drug that suppresses the central nervous system can lead to cardiac arrest, coma, difficulties breathing, and death.
Drug dependence is another potential side effect of Suboxone abuse. When suffering from a dependence on opioid drugs, an additional risk factor in abusing Suboxone is that it may precipitate withdrawal symptoms – that is, it might induce a withdrawal syndrome to start. If Suboxone is injected, the naloxone can become effective at blocking the opioid receptors in the brain and starting withdrawal. Opioid withdrawal can be significant, causing symptoms similar to a really bad case of the flu physically. It can also induce depression, anxiety, insomnia, mental “cloudiness,” confusion, short-term memory issues, and overall malaise and difficulties feeling pleasure. Withdrawal symptoms are signs of opioid dependence. Drug cravings and an inability to control how much, or how often, one takes these drugs are signs of addiction involving opioids.
When someone takes Suboxone recreationally, or without a legitimate prescription, they may appear drowsy and sedated, slur their speech, have impaired reflexes and motor coordination, seem happy and mellow, and have difficulties thinking straight and remembering things. Other signs of Suboxone abuse include:
- Social withdrawal and changes in peer groups
- Increased secrecy
- Time spent online in drug forums and chat rooms
- Financial difficulties
- Decline in production at work or drop in grades at school
- Changes in appetite and weight fluctuations
- Marked difference in sleeping patterns
- Mood swings and potential personality shift
- Lack of interest in activities or things that used to be a priority
- Increased risk-taking and out-of-character, possibly erratic, behaviors
- Shirking of normal responsibilities
- Potential criminal activity or legal troubles
When someone abuses a drug like Suboxone regularly, they may become dependent on it, which means that medical detox is the safest way to stop taking the drug. The FDA warns individuals to not stop taking Suboxone suddenly, since withdrawal may start upon discontinuation of the drug. During medical detox, Suboxone dosages may be tapered down over a period of time in a slow and controlled manner to reduce withdrawal symptoms. Other medications or supplements may be useful for specific symptoms of withdrawal as well. Detox is an essential part of the recovery process, but it does not constitute addiction treatment; it must be followed by a comprehensive treatment program.
Treatment for Suboxone abuse may be provided in an outpatient or residential format, depending on the specific needs of the person. Both models generally include behavioral therapies and counseling sessions to help individuals learn new coping mechanisms, communication skills, and tools for managing cravings and potential stressors or triggers. Support groups can be great forums for individuals to connect with peers and others who can offer hope for recovery as well as advice on preventing relapse and remaining drug-free. Families and loved ones can attending counseling sessions and educational programs as well in order to better understand how to provide support and understanding going forward.
Treatment for Suboxone abuse is highly individual, and it often begins with a comprehensive assessment to guide highly trained professionals as they map out the person’s care plan. While addiction involving Suboxone carries with it a bevy of dangerous side effects, recovery is possible.
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