What does your doctor say
about Suboxone?
Dr. Sadia Dar
August 31, 2013
Suboxone: a drug to treat
Opioid dependence & addiction
Buprenorphine was discovered in 1970’s in Europe by
Scientists who were researching a drug to help with
withdrawal symptoms and dependence caused by
painkillers
It has been used in Europe for more than 2 decades
for both treatment of Opioid dependence and pain
The drug was studied in the United States and got its
FDA approval only for treatment of Opioid
dependence in 2002
Suboxone is not approved by FDA for treatment of
pain
Reckitt Benckiser, the pharmaceutical manufacturer of
the drug has not shown interest for indication of
Suboxone for pain
Suboxone and Subutex are schedule 3 and controlled
substance
Subutex is only approved for treatment of Opioid
dependence during pregnancy, or for patients who are
admitted and under direct supervised treatment
Both Suboxone and Subutex are known for its
potential for abuse and diversion
Suboxone and Subutex can be injected intravenously
and used for treatment to get “High”
Intravenous use of either one of those drugs can, and
is known to cause death
When Suboxone/ Subutex is taken with other
controlled drugs, for e.g., Benzos, it can cause
respiratory failure and death
Suboxone: is a combination of Buprenorphine and
Naloxone
Buprenorphine is a partial mu agonist with much more
potent effect on mu receptors than morphine, the
effect lasts at least 18 hours and up to 1 week. The
drug does not work on kappa receptors
Due to its partial mu receptor properties, the drug has
analgesic (pain relieving) effect.
Naloxone is an Opiate blocker
How will suboxone help me
overcome my addiction to
Suboxone competitively binds to the receptors in the
Opioids?
brain to stop the cravings for Opioids and the
naloxone part of it, blocks the receptors so you do not
feel the effects of Opioids in the system
Over time, as the medicine completely occupies the
receptors to stop the cravings, the number of active
receptors goes down
The receptors start to down regulate and shut down
Different people have different number of receptors in
the brain
So, the time it takes for one person to fully recover is
different from time it may take for another person
Based on duration of addiction and dependence, for
some people addiction is considered a chronic
disease and it may be necessary for them to stay on a
low dose Suboxone for long term, just like you would
for treatment of High Blood Pressure and Diabetes
Psychosocial support and counseling to help modify
the addiction behavior is extremely important in
overall treatment of Opioid dependence
For most Opioid addiction clinics, it is mandatory that
you receive appropriate and effective counseling
Withdrawal Symptoms with
Suboxone
Chronic use of Suboxone and Subutex can cause
dependence similar to Opioids. Abrupt use of the
medicine can cause withdrawal symptoms, although
symptoms may be milder and delayed in onset
Due to presence of Naloxone, if suboxone is
administered in the presence of Opioids in the
system, it can cause severe withdrawal symptoms.
That is why your doctor may require you to take the
first dose of the medicine in direct supervision
When can you stop Suboxone
You and your doctor can decide the wean down
process from the suboxone.
Typically, Suboxone dose is tapered slowly over
several weeks and months till it can be completely
stopped.
It is advisable to communicate closely with your
doctor, your counselor and your support system
during this wean down process.
During the process, you may notice increase in
In most cases, those symptoms are easily
manageable and treatable with non-Suboxone
medication.
It is extremely important to be compliant and adhere
to the treatment plan when weaning down from
Suboxone.
Drug Diversion
Unfortunately, Suboxone has a known street value
and widely diverted among drug users.
Due to its known efficacy in treatment of Opioid
dependence, in most cases, it is diverted and/ sold to
people who have a problem with addiction and they
are trying to self treat.
On the other hand, some addicts try to experiment
with Suboxone to get high. Intravenous use of the
drug (although very dangerous) but can cause the
feeling of euphoria.
Due to a rise in diversion and street value of
Suboxone, Drug Enforcement Agency and law
enforcement agencies work with doctors and experts
very diligently to minimize it.
In several states, including the state of TN, it is the
law to check central drug database, before a
prescription of a controlled substance can be written
or dispensed to a patient.
It is your responsibility to inform your doctor(s)
immediately if you are being prescribed a controlled
substance.
As doctors and health care providers, we feel the
responsibility to take measures to stop the diversion
of this otherwise very beneficial and powerful antiaddiction medicine.
Most offices and practices have policies and protocols
in place to minimize drug abuse and to stop diversion
of the drug.
Our policy is to help you and to help the community
we all share.
Our Policy
We do everything in our capacity to help you get off
the narcotics and stay off of them.
We do not prescribe Suboxone if there is a
reasonable doubt or suspicion that you may be
diverting the medicine.
We ask that you bring all the film wrappers with you to
your appointments.
If you are prescribed tablets, we can call you for
random pill count.
We can call you for random drug screen at any time.
Its your responsibility to come for a random drug test
if we ask you to come.
It is your responsibility to call us if there is a change in
your address, your phone or contact number.
It is your responsibility if you change your pharmacy.
It is your responsibility to “say No to drugs” when it is
offered to you whether in the form of a drug or a
prescription.