As medication-assisted treatment (MAT) for opioid and alcohol use disorder has become an integral element of the modern addiction care paradigm, Suboxone® has become one of the most commonly used resources in the practice. Suboxone is a combination of buprenorphine and naloxone, and is one of a select few medications approved for MAT. Other drugs include methadone and Vivitrol® (extended-release naltrexone for injectable suspension). Suboxone was approved in 2002 and has had a mixed legacy ever since.
While many patients at Suboxone treatment centers have been able to achieve long-term abstinence from opioids and alcohol by using it, others have become addicted to the opioid-based medication itself, creating a whole new substance use threat for new populations. Since its approval, Suboxone has become a fixture in MAT. Ten years after its approval, the drug was generating over $1.5 billion per year. This widespread use, however, has created casualties: a 2013 study from the Substance Abuse and Mental Health Services Administration (SAMHSA) revealed a tenfold increase (3,161 to 30,135) in ER admissions from 2005 to 2010. This timeline coincides with the approval of Suboxone for clinical use.
There are two active ingredients in Suboxone, buprenorphine and naloxone. Buprenorphine is an opioid agonist that works by binding to opioid receptors to prevent withdrawal symptoms through a safer, smaller, and more controlled dose of opiates. It is meant to replace the need for more dangerous and more powerful opioids like heroin and prescription painkillers. Over time, the need for buprenorphine is meant to dissipate, and patients are supposed to taper off the drug for complete opioid abstinence.
The naloxone in Suboxone is meant to prevent or discourage misuse of the medication. If the drug is crushed, snorted, or misused in any other way, the naloxone is supposed to block opioids from reaching the brain’s receptors. Professionals at Suboxone treatment centers provide in-depth explanation of the drug’s impact on neurochemistry.
Suboxone treatment is the controlled and medically supervised administration of Suboxone by a qualified and credentialed medical professional. Each phase of the Suboxone treatment process should be overseen by the prescribing physician, and it’s critical that patients communicate with their doctors regarding any misuse or changes in symptoms they’re experiencing while on the drug. Suboxone treatment can take place in both inpatient and outpatient settings. It is often coordinated in inpatient treatment and continued in outpatient Suboxone treatment centers. Patients should wait at least twenty-four hours after their last dose of opioids (painkillers and heroin) before starting Suboxone.
The duration of Suboxone treatment varies from patient to patient depending upon a specific patient’s progress, but treatment can last for months or even years. In one study, researchers from the Center for Drug Safety and Effectiveness at John Hopkins University found that the average length of Suboxone treatment was fifty-five days. The goal of Suboxone treatment is complete abstinence, and patients and their physicians should always be working toward tapering off the drug. Physicians must complete certification training pursuant to the Drug Addiction Treatment Act of 2000 before they can prescribe Suboxone to their patients, and they can only prescribe the drug to 275 patients at a time—a cap that was increased from 100 in 2016 by the Obama Administration, due to the escalating opioid epidemic in the United States.
The effects and withdrawal symptoms of Suboxone often mirror those of other opiate-based drugs. While each patient’s experience will be different according to their substance use history, there are multiple common side effects:
If you’re experiencing these or any other symptoms related to your Suboxone use, consult your prescribing medical professional immediately. Patients should not drink while taking Suboxone.
The price of Suboxone varies based on a number of factors, including insurance coverage, whether the patient is getting generic or brand-name, Medicaid coverage, potency, the individual pharmacy, and more. The average out-of-pocket cost (without insurance) for fourteen two-milligram films of Suboxone is usually between $60 and $65. The average price for the supply at the twelve-milligram interval is usually between $200 and $220. The FDA very recently approved the first generic versions of Suboxone, which will likely bring costs down. Suboxone treatment may be covered under Medicare, Medicaid, and employer-based health insurance, depending on each patient’s state of residence and their individual healthcare provider.
More and more Suboxone treatment centers are opening; to find a center near you, consult SAMHSA’s Treatment Practitioner Locator tool or simply contact your state mental and health and addiction services agency.
While Suboxone has become a commonly used tool to help patients achieve long-term abstinence from heroin and prescription opioids, it is also a dangerous and addictive drug, the diversion and misuse of which has added an extra layer to the opioid addiction epidemic. Diversion and abuse have become a serious problem, as discussed in one comprehensive study from Brown University, another from the University of Kentucky, and many others. The National Council on Alcoholism and Drug Dependence reports that police seizures of Suboxone rose from 90 in 2003 to more than 10,000 in 2010.
These figures clearly signal an alarming increase in Suboxone diversion and abuse, and it’s imperative that you protect yourself or your loved one from misuse of this powerful opioid-based medication. But if you think that Suboxone treatment may be helpful in helping you through opioid addiction, find out the right way. Talk to your physician to find out more about the pros and cons of Suboxone treatment centers.
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