A Powerful Tool Against Opiate Addiction
Over the past few decades, several promising medications have been introduced into the addiction treatment landscape. These drugs have helped with a variety of addiction disorders, from alcohol to heroin to prescription painkillers. One of the more commonly utilized examples of these medications is a drug called buprenorphine, known to consumers as Suboxone®. Suboxone is a combination of buprenorphine and the anti-overdose drug naloxone. It is the first opiate and opioid treatment medication to be legally dispensed by general care physicians, as opposed to its predecessor methadone, which required a special trip to a clinic. Suboxone can also be highly addictive and requires close monitoring by the prescribing physician.
The Context of Suboxone Treatment
Suboxone treatment is not meant to replace other aspects of treatment, but is meant to exist as part of an overall care approach. This includes rehab, behavior modification, group therapy, individualized counseling and specialized supplemental therapies.
Some of the dangers associated with Suboxone treatment include:
- Fever and Flu-Like Symptoms
- Fatigue and Soreness
- Joint and Muscle Pain
- Disorientation and Confusion
- Trouble Sleeping
- Trouble Breathing
- Sweating and Dry-Mouth
- Seizures and Convulsions
- Intense Cravings
These symptoms should be closely monitored by your prescribing physician who can adjust your dosage accordingly. If you are currently on Suboxone, it’s imperative that you speak with your doctor before adjusting or stopping use.
What Does A Suboxone Treatment Plan Entail?
Before exploring the possibility of any Suboxone regimen, it’s important to realize that this drug is not a substitution for traditional treatment and rehab, nor is any other. Suboxone should be taken as part of a comprehensive overall treatment plan, which includes counseling, detox, supplemental therapies and ongoing monitoring. The overall goal of Suboxone treatment is to end the abuse or misuse of opioids, and to try to help patients manage their condition. Each person’s case is different, and the doctor who treats your opioid dependence should work with you to create a treatment plan that fits your specific needs. Patients will work closely with their prescribing physicians during each phase of Suboxone treatment to ensure safety from diversion and abuse. Unlike its predecessor methadone, Suboxone can be used at a home and does not require a trip to a clinic. Typical Suboxone treatment plans often look like this:
Week 1: Doctor will prescribe approximately 8 mg to 16 mg on the first day. The first treatment typically takes two hours and can include a variety of withdrawal symptoms. Your doctor will guide you regarding urine tests, follow-up visits and withdrawal relief during this period.
Week 2: This is often the week some patients test the blocking effect of the Buprenorphine. They use drugs to see if it really blocks the effects, or just reduce them as with methadone. Whether you test it out yourself or learn from other’s mistakes, the result is the same. The Buprenorphine completely blocks other opioids and not only do you relapse but you receive no high and waste the money spent on drugs. Once you realize this, you find you no longer need to constantly debate between use and sobriety. If you wanted to use, you would have to be off the Buprenorphine for at least three days. Hopefully you would have one strong moment in that time, and take your Buprenorphine.
Weeks 3-4: Patients will continue their programs according to their doctors’ instructions.
Remaining Months: Eventually patients can consult with their doctors regarding gradual weening off Suboxone. This should only be done under the watchful eye of an experienced physician. Patients who quit Suboxone abruptly run the risk of numerous adverse health effects and withdrawal symptoms.
Regulation of Suboxone
There is constant institutional flux regarding the safety and efficacy of Suboxone treatment. Fears of diversion initially caused regulators to limit the amount of Suboxone and other buprenorphine-based drugs that one doctor can prescribe to 30 patients at a time. This was quickly changed to 100 and most recently increased to 275. The overall goal of treatment is to end the abuse or misuse of opioids, and to try to help patients manage their condition. Each person’s case is different, and the doctor who treats your opioid dependence should work with you to create a treatment plan that fits your specific needs.
Fears of diversion are not unfounded, however, as many Suboxone users end up replacing one addiction for another. Both the pills and the strips find their way into prison. The pills can be brought in by the guards, or smuggled through the visiting room, or even sent in by anyone who owns a canning machine and can print labels. You can get anything into prison with a canning machine and a labeler. Suboxone is also widely available on the streets.
Alternatives to Suboxone
Patients may have access to other medication-assisted treatment resources, including Vivitrol, which can also be used for alcoholism. Vivitrol is a non-narcotic medication that is used in the treatment and management of alcohol dependence and in the prevention of relapse for opioid dependence. Vivitrol was approved by the FDA for treatment of alcohol dependence in 2006 and for relapse prevention from opioids in 2010. It is given once a month and is administered via intramuscular injection by an addiction specialist, or in a controlled medical setting such as a treatment center by a licensed medical professional. It dramatically reduces the psychological craving for alcohol. In the context of addition, it prevents the relapse for opioid abuse for patients being treated for opioid addiction after the patient has completed detoxification. This makes Vivitrol much more manageable compared to other anti-addiction medications such as Suboxone, Topamax, or Campral that require daily maintenance over the course of several years.
The active ingredient in Vivitrol (naltrexone for extend-release injectable suspension) is an opioid antagonist that binds to the brain’s opioid receptors. This stops the stimulation of the brain’s reward system from responding to any opioids that may be administered, rendering the patient incapable of feeling any of the pleasurable effects of the drugs. This removes any incentive for continued abuse of opioids. This also affects the body’s endorphin response to alcohol, causing a reduction in the desire to drink. It is designed to be time released and therefore is only require to be administered once every twenty-eight days. Vivitrol does not prevent the effects of other non-opioid narcotics or alcohol.