What is suboxone
There are more than 200 opioid overdose deaths each day in the US. In combating this epidemic we look to available treatment tools. Here, we find only three medications approved by the Food and Drug Administration (FDA) for the treatment of opioid use disorder. Of the three, buprenorphine is of particular importance due to its reduced overdose potential as a partial opioid agonist. Evidence supports its clinical equivalence to its full agonist cousin methadone, and suggests that it is better slated for long-term treatment of opioid use disorder compared to the non-selective opioid antagonist naltrexone. Buprenorphine is most popularized within Suboxone, a medication which also contains the non-selective opioid antagonist naloxone. The naloxone has no additional effect when the drug is taken as instructed, as it is intended to prevent diversion in those that would attempt to inject the medication. While Suboxone is regarded by some as the future of medical treatment, others have expressed concerns. This review aims to explore the history, controversy, and open questions that surround buprenorphine and its most prescribed variation, Suboxone.
Medical use of suboxone
Suboxone is used to treat opioid use disorder, which is the clinical diagnosis for opioid addiction. Medications are increasingly becoming the standard of care for managing OUD. If you enter rehab for opioid addiction, you may receive medications for addiction treatment as an integral part of your program strategy. Medications like Suboxone for addiction treatment are one part of the treatment plan, which also incorporates counseling and behavioral therapy for substance use disorder
Method of suboxone administration
The following buprenorphine products are FDA approved for the treatment of OUD:
Generic Buprenorphine/naloxone sublingual tablets
Buprenorphine sublingual tablets (Subutex)
Buprenorphine/naloxone sublingual films (Suboxone)
Buprenorphine/naloxone) sublingual tablets (Zubsolv)
Buprenorphine/naloxone buccal film (Bunavail)
Buprenorphine implants (Probuphine)
Buprenorphine extended-release injection (Sublocade)
Common and serious side effects of suboxone
Common side effects of buprenorphine include:
Constipation, headache, nausea, and vomiting
Dizziness
Drowsiness and fatigue
Sweating
Dry mouth
Tooth decay
Muscle aches and cramps
Inability to sleep
Fever
Blurred vision or dilated pupils
Tremors
Palpitations
Disturbance in attention
Serious side effects of buprenorphine include:
Respiratory distress
Overdose
Adrenal insufficiency
Dependence
Withdrawal
Itching, pain, swelling, and nerve damage (implant)
Pain at injection site (injection)
Neonatal abstinence syndrome (in newborns)
Precaution and contraindications
Buprenorphine use is contraindicated only in patients with hypersensitivity reactions to it. Caution should be exercised in patients with respiratory depression and gastrointestinal obstruction. In addition, buprenorphine is not recommended for patients currently using full opioid agonists, such as heroin or morphine. Concurrent use of a full and partial agonist may result in acute withdrawal, defeating the purpose of buprenorphine administration (refer to the "Monitoring" section). Patients with known or suspected gastrointestinal obstruction, including paralytic ileus, are not recommended to use buprenorphine buccal film, immediate-release injection, and transdermal patch due to the risk of exacerbating the obstruction. Oral mucositis can accelerate absorption from buccal film and raise buprenorphine plasma levels. Healthcare providers should lower the dosage and carefully monitor for signs and symptoms of toxicity or overdose in patients experiencing oral mucositis.
Buprenorphine exerts some anticholinergic-like effects and may cause CNS depression, hypotension, QT prolongation, and lower seizure threshold. Additional adverse effects of buprenorphine include nausea, vomiting, drowsiness, dizziness, headache, memory loss, sweating, dry mouth, miosis, orthostatic hypotension, sexual adverse effects, and urinary retention.
Following buprenorphine treatment, a patient's tolerance to opioids may diminish, posing a potential risk if they resume their previous opioid dosage. Therefore, patients must recognize their heightened sensitivity to low opioid doses and promptly inform their healthcare provider of any unusual symptoms. Moreover, patients should be strongly advised against using opioids without prior consultation with their healthcare provider.
Patients should be cautioned about engaging in activities requiring mental alertness, such as operating machinery or driving, as buprenorphine may cause CNS depression.
Hepatitis and liver impairment, ranging from transient, asymptomatic transaminase elevations to liver failure, may occur, particularly in patients with preexisting hepatic impairment.
Hypersensitivity reactions have been reported, ranging from rash, hives, pruritus, and bronchospasm to anaphylactic shock
Buprenorphine may significantly lower blood pressure levels, which can result in orthostatic hypotension or syncope. Caution should be exercised when administering buprenorphine to individuals with hypovolemia, cardiovascular disorders, including recent myocardial infarction, or those concurrently using medications that may amplify hypotensive effects. Monitoring for signs of hypotension is advisable after initiating or adjusting the dosage
Patients testimonial and experiences
"Been on Subs for 7 years and wanting to come off, so I got on here to look at reviews! I would have to say if not for Suboxone, I would be dead or still using other drugs! After reading, I am going to try to taper off, starting tomorrow. I think after a long period of time taking it, you have no energy. I could sleep all day, not to mention the numbness I feel in my hands, feet, or even my head sometimes! I think it’s the side effects from Suboxone. That’s why I'm gonna try tapering and not just cold turkey! I will post back next week to let you all know (to whoever cares) results!"
"I just recently quit Suboxone cold turkey from 24 mg. I was on Subs for over 6 years. I'm now in week three and I can still barely sleep. Still, my legs and back are in constant pain, and the only relief I get is to have hot baths. My advice is to quit whatever you're on instead of switching to a long-acting opiate. It takes so much longer to get off, and the withdrawals are pretty much the same but just prolonged. I can't wait to feel normal again!!! Worst experience ever, but I've been through so much the last few weeks I'll never touch an opiate again. Time to get on with life."
Medical advice before starting suboxone
People taking short-acting opioids (like heroin or Vicodin) typically wait 12 to 24 hours after the last dose.
People taking long-acting opioids (like morphine or OxyContin) typically wait 36 hours after the last dose.
You must show signs of withdrawal (like dilated pupils or goosebumps) before starting Suboxone.
Doctors often use the Clinical Opiate Withdrawal Scale (COWS) to measure withdrawal severity. A score of 8 to 11 on COWS indicates you can begin Suboxone