In the Classroom

FREQUENTLY ASKED QUESTIONS

What is Suboxone (Buprenorphine)

Suboxone (Buprenorphine) is one of the few drugs approved by the FDA to treat opioid addiction. It is a partial opioid agonist which is an important property that can make the following possible.

  • very effective at reducing cravings for opioids and other painkillers so risk of relapse is decreased significantly

  • suppresses or prevents opioid withdrawal symptoms

  • less euphoria or pleasure associated with its use

  • decreases or blocks effects of other opioids and painkillers

  • ceiling effect occurs so increasing amounts of the drug does not increase levels of euphoria

  • less respiratory suppression than full opioid agonists such as methadone or other opioids which greatly reduces the risk of overdose

  • withdrawal symptoms when stopping medication is less severe

  • lower potential for abuse or misuse do to ceiling effect

Suboxone (Buprenorphine) comes in the following formulations for the treatment of opioid use disorder.

  • Zubsolv sublingual tablets are a Buprenorphine and Naloxone combination tablet

  • Suboxone sublingual films are a Buprenorphine and Naloxone combination film

  • Sublocade injection is a extended-release Buprenorphine

The decision on which product to use is made by the doctor after evaluating the patient.

What is the difference between Suboxone (Buprenorphine) and Methadone?

Suboxone (Burprenorphine) has less potential for abuse and misuse than Methadone. This is partly because it does not fully bind to the opioid receptors in the brain. As a result of this partial binding the users do not experience the same "getting high" feeling they get from Methadone and other fully binding opioids such as heroin and fentanyl. This difference is one of the reasons that Suboxone (Buprenorphine) is safer than Methadone. One study in the UK conducted over a 6-year period recorded 2,366 deaths related to Methadone and 52 related to Suboxone (Buprenorphine).

Is Suboxone (Buprenorphine) trading one addiction for another?

No, absolutely not! Addiction is a behavioral disease in which a compulsion exists to use substances or participate in other activities that trigger the brains reward system. In essence addiction is caused by flawed mental processes that have been reinforced through our brains reward system. This reward system can be triggered if you use a substance or do a specific activity. It causes instant gratification and pleasure temporarily but over the long-term it causes pain, misery, loss of motivation, and other psychological problems.

The long lasting effects of Suboxone (Buprenorphine) reduce or eliminate the compulsion to use because the patient does not experience "ups and downs" between doses. The ceiling effect on pleasure from Suboxone (Buprenorphine) means that patients do not feel any more pleasure from taking higher and higher doses of the drug which also helps reduce the compulsion to use. Once the compulsion to use has been eliminated then the patient is no longer experiencing addiction to a substance. There is a huge difference between physical dependence and addiction.

Once the patient is no longer experiencing addiction, their lives and thought processes become more stable. At this point there is an opportunity to rebuild positive and healthy thought processes that can lead to prosperous and successful lives filled with true happiness.

Induction: How hard is it to start Suboxone (Buprenorphine)?

Transitioning from full agonist opiates and opioids to Suboxone (Buprenorphine) can be scary to some clients. The most common fear is whether or not they will experience withdrawal symptoms while switching. When induction is done correctly most clients experience little to no withdrawal symptoms. If mild withdrawal symptoms are experienced they typically go away within the first day. Our goal is to make the induction phase as smooth and comfortable for our cleints as possible.

 

Do I stay on Suboxone (Buprenorphine) forever or do I stop at some point?

The answer is different for each patient and depends on what the patient wants. Some patients enjoy the stability that a Suboxone (Buprenorphine) maintenance program brings to their lives and are happy continuing the treatment indefinitely. There is no shame in taking medication prescribed for a disease. It is unfortunate that our society stigmatizes mental diseases, although as our understanding of mental diseases increase so does our tolerance for the diseases. A diabetic does not feel shame about taking insulin every day for their disease and our patients should feel the same way about Suboxone (Buprenorphine) maintenance for their disease.


Other patients see Suboxone (Buprenorphine) maintenance as a stepping stone to a life without the need for medication. This is done in a slow and controlled manner that ensures the patient is not being put at unnecessary risk. It is very important to first get stability then work on reinforcing positive behaviors and stopping negative behaviors. Once a patient has stability both mentally and physically then the dose of Suboxone (Buprenorphine) can be slowly decreased and eventually stopped. We do this slowly to ensure the patient does not experience unnecessary withdrawal effects and cravings that could cause them to start using their drug or drugs of choice again which is called a relapse.

What is Vivitrol (Naltrexone) injections?

Vivitrol is a controlled release Neltrexone injection that is done every 30 days. When used with proper counseling it can lower cravings for opioids and alcohol. It also prevents opioids from properly binding to opioid receptors in the brain. This means that if a patient uses an opioid while on Vivitrol (Naltrexone) the effects will be greatly reduced or they will notice no effect from the drug. By reducing or eliminating the effects of opioid use especially euphoria the compulsion to use can be decreased which reduces the risk of relapse.

Vivitrol (Naltrexone) can also be used to provide a safety net while discontinuing a Methadone or Suboxone (Buprenorphine) maintenance program.


It is important to note there is a risk of opioid overdose when using Vivitrol (Naltrexone) especially if the medication and/or counseling is abruptly stopped.

 

How often will I be seen?

Typically patients are seen on a monthly basis after beginning a Suboxone (Buprenorphine) or Vivitrol (Naltrexone) maintenance program. Program compliance is one factor that can determine how often a patient will be seen by the doctor. However, treatment plans are customized to meet each patients' needs and the final decision on frequency of visits is determined by the doctor after a patient consultation.

Will I miss work while starting Suboxone (Buprenorphine)?

Patients should plan to take off work the first day of Suboxone (Buprenorphine) induction so they can get used to the effects of the medication. The majority of patients return to work the day after induction. However, some patients are able to begin working the day they start treatment. The decision is up to the patient and what they feel comfortable doing.

Will Suboxone (Buprenorphine) show up on my employer drug tests?

Suboxone (Buprenorphine) does not show up as an opiate on drug tests and methadone, oxycodone, hydrocodone, heroin, demerol, and other opioids test for different metabolites than those produced from Suboxone (Buprenorphine). The majority of tests do not include testing for Suboxone (Buprenorphine) so if the patient is only taking his prescribed Suboxone (Buprenorphine) he will not screen positive unless they are specifically testing for it.

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