Subutex and Suboxone are both medications that contain buprenorphine, a substance used to treat opioid addiction. Buprenorphine is a semisynthetic opioid, but it has been designed to be less addictive than drugs like heroin, morphine, and Vicodin. People who become addicted to an opioid can be prescribed buprenorphine, which they take in place of the stronger opioid in order to reduce cravings and withdrawal symptoms. They can then be slowly weaned from the buprenorphine or, in some cases, it may be recommended for long-term maintenance treatment if complete abstinence from opioids does not appear to be an option.
Opioids like heroin are some of the most addictive substances in the world. Ceasing use of drugs like heroin after becoming addicted can be incredibly difficult – for some, it may seem impossible. The withdrawal symptoms alone are enough to deter people from trying to get clean. Opioid withdrawal symptoms can include:
- High blood pressure
- Runny nose
- Teary eyes
- Muscle aches
- Stomach cramps
- Dilated pupils
- Rapid heartbeat
Though none of these symptoms are particularly dangerous, combined with intense cravings, many people need help overcoming them and avoiding relapse.
Currently, heroin abuse is on the rise, and the abuse of prescription opioid painkillers like Vicodin and Percocet has been an increasing problem for decades. In 2014, it was found that 1.9 million people in the US alone had a substance use disorder involving prescription painkillers, according to the American Society of Addiction Medicine.
More options for medicated addiction treatment have been sorely needed. However, buprenorphine is still an opioid and therefore addictive. Though people addicted to strong opioids like heroin are unlikely to find buprenorphine attractive due to its comparatively mild high, it can be very addictive to those who have never abused an opioid before. Therefore, measures needed to be taken to try and prevent abuse of drugs containing buprenorphine.
Subutex is simply a brand name for buprenorphine. It comes in small tablets that are meant to be dissolved under the tongue. This way, some of the substance is absorbed quickly into the system through the mucus membranes in the mouth, and the rest of it is swallowed and absorbed more slowly through the digestive system. This allows the individual to get a quick dose to stave off withdrawal and cravings but also only have to take one pill per day as the rest is slowly distributed in the body. Buprenorphine is long-lasting to the point that it often only needs to be taken every other day.
This treatment has been found to be fairly effective. One recent study found that 54 percent of patients treated with buprenorphine remained sober for at least six months.
Subutex was first approved for the treatment of opioid addiction in the United States in 2002. Due to the fact that it still has the potential to be abused and produce addiction, it’s classified as a Schedule V controlled substance. Subutex has been known to be sold on the black market after being fraudulently obtained via prescription or even stolen from medical facilities. The tablets can be crushed for snorting or melted into a solution for injection to produce a more intense high. This became popular among those who want to experiment with opioids but fear the dangers and high addiction potential of other commonly abused opioid drugs.
Suboxone was developed to combat the problem of buprenorphine abuse. It’s a mixture of buprenorphine and a drug called naloxone, which is an opioid antagonist. Naloxone blocks opioid receptors in the brain, making it impossible for any opioid drug to work. However, in Suboxone, this substance is only activated if the tablet is crushed or dissolved, as Subutex sometimes is for abuse purposes. If it’s taken as it’s meant to be taken, via dissolving under the tongue, the naloxone has no effect and passes out of the system harmlessly.
Though the naloxone helps lower abuse potential, individuals can still abuse Suboxone. Those who have no tolerance to opioids will still experience a euphoric high, and it can be abused simply through taking more than one at a time or by taking a few during a 24-hour period. This abuse can also lead to addiction, just like with any other opioid, or users may look for a better high by switching to more dangerous drugs like heroin.
It’s also important to note that the naloxone, if activated, can produce instant and severe withdrawal symptoms. It’s so effective at blocking the opioid aspect from working that those addicted to opioids already will quickly find themselves very sick. However, opioid withdrawal symptoms are not generally as dangerous as withdrawal from other classes of intoxicants can be.
An Alternative to Methadone
Buprenorphine was designed as an alternative to methadone, a popular substance used to treat heroin addiction in the same way. The problem with methadone is its high potential for overdose, which is so dangerous that its dispensation needs to be tightly controlled. In 2009, it was found that methadone deaths had risen sevenfold from 1999 to 2006. Doses of methadone need to be given directly by a medical professional; it can not be taken home for self-administration.
This can be a significant barrier to treatment, as traveling to a hospital or specialized treatment center every day costs time and money. Buprenorphine has a low potential for overdose and can therefore be given out like any common prescription medication. It also has less potential for abuse than methadone, as the high it produces levels out after a certain amount of doses.
Buprenorphine was something of a breakthrough after around 40 years of methadone being the only option for medicated opioid addiction treatment. However, even with the help of this medication, it can be very difficult to quit. It’s highly recommended for anyone addicted to an opioid to combine any medication treatment with therapy that involves emotional support.
Addiction is not just about physical symptoms and cravings. There are many options for support groups, 12-Step programs, and group or individual therapy. Combining treatments is much more effective than relying on one alone.