Suboxone (buprenorphine) and methadone are the two leading medications available for the treatment of opioid addiction. They are both opioid replacement therapies that, when taken regularly, will prevent an individual from experiencing opioid withdrawal sickness. Suboxone was approved by the FDA in 2002, and this allowed local physicians to begin prescribing Suboxone from their offices to opioid addicted patients seeking help.
This was a landmark achievement in consumer choice and provided people another very useful option for dealing with opioid addiction. To treat a patient with suboxone, a physician must first complete a comprehensive course, and become approved, before being allowed to prescribe the medication.
Since opioid replacement medication by itself addresses only the underlying physiological dependence (but not the related psychological contributors to addiction), patients are required to obtain substance abuse counseling as a part of their suboxone treatment. This additional requirement helps to ensure that patients are receiving education & training in understanding their addiction, and in identifying methods for preventing opioid relapse in the future.
Many suboxone-approved physicians do not provide this supplemental addiction counseling, and will consequently refer their suboxone patients to local providers who offer drug treatment services.
While suboxone and methadone are similar in action, they are unique enough to offer distinctly different advantages. You can review our comparison chart to examine some of the differences between the two medications. Both methadone and suboxone are slow acting, long lasting opioid agonists that bind to the body's opiate receptors. This particular action eliminates opioid withdrawal sickness very effectively, and thus allows individuals to resume their daily lives.
Suboxone is actually a branded medication & product of the pharmaceutical company, Indivior. Suboxone is currently available as a thin film that is held under the tongue until the medication dissolves. Once dissolved, the medication is naturally absorbed through the tissues under the tongue and into the bloodstream. The newer film formulation dissolves somewhat more quickly than the previously available tablet form.
Suboxone is generally taken once per day although some patients with a milder opioid dependency may be able to take the medication every other day and remain comfortable. Suboxone does not produce a drug high for tolerant users, and does not interfere with one's daily activities. Many patients report feeling very comfortable while being maintained on suboxone and also during their gradual taper off of the medication.
What is in Suboxone?
Suboxone is a combination of buprenorphine and naloxone. Buprenorphine (an opioid agonist) is the ingredient that binds to opiate receptors and provides relief by blocking withdrawal symptoms (very similar to methadone). Naloxone is an opioid antagonist that reverses the effects of opiates and will cause withdrawal. This seems like a strange paradox having both ingredients in one tablet. However, do not worry. Remember, Suboxone is dissolved and absorbed under the tongue. The antagonist, Naloxone, becomes inert (has no effect) when dissolved under the tongue. So one only experiences the benefit of the Buprenorphine.
Why is Naloxone Added to Suboxone?
Specifically to discourage & prevent injection use of suboxone. Some addicted individuals may try to inject suboxone to obtain a drug high. When they do so, the Naloxone becomes immediately active (since it's being injected directly into the bloodstream), and it brings on sudden withdrawal symptoms making the individual feel very sick. This reinforces a person for using suboxone the proper way (under the tongue), and prevents future attempts at injecting suboxone.
How Do I Know if Suboxone is Right For Me?
This is a great question although a little difficult to answer. Suboxone tends to be effective for a considerable number of people addicted to opioids. Many of those who do well with suboxone are people who have a relatively shorter duration of opioid addiction or whose addiction is based on a comparatively smaller amount of daily opioid use. Heavy opioid users with a longer history of addiction sometimes respond better to methadone. However, there are notable exceptions.
Suboxone has a ceiling effect around 24-32 mg of medication daily. 32 mg is generally considered to be the dose at which maximum withdrawal relief is provided. For most addicted people, taking more than 24-32 mg of suboxone daily will not provide any more additional relief. Methadone has no such ceiling effect and its dosage levels can be raised much higher, consequently providing a greater level of comfort and symptom relief for more severe opioid dependencies.
In conclusion, 8 mg to 32 mg of suboxone may provide excellent relief for someone new to medication-assisted recovery. If they find that suboxone is not strong enough to manage their withdrawal symptoms, then methadone most certainly will since it has no "ceiling effect".
Taper programs aim to stabilize an opioid addicted individual on suboxone for a brief period of time and then taper their dosage down over a 60 to 90 day period. This taper period is not set in stone and can vary depending on the individual's need. The primary goal is to stabilize with suboxone and to then taper off with the end result being complete freedom from opioids and opioid replacement medication. Some patients do very well with a scheduled taper. Other patients may find that tapering is problematic and will switch to a period of maintenance. Maintenance with suboxone is effective and safe, just like with methadone. Upon first entering the market, Suboxone was mostly used for tapering off of opioids. However, it is commonly used today for extended maintenance in similar fashion to methadone.
For more on Suboxone Doctors, read: www.Methadone.us/suboxone-doctors/
Methadone programs and doctors who prescribe buprenorphine serve a very important function in helping the country cope with the opioid crisis. They are also a life-saving link for patients who have suffered for years with an overwhelming addiction.
Operating a methadone clinic or buprenorphine/suboxone practice is typically a complex endeavor. Clinics that offer medication-assisted treatment (MAT) must comply with a myriad of mandates and policy requirements from the DEA, the local State Methadone Authority, accreditation organizations like CARF and JCAH, SAMHSA (the Substance Abuse and Mental Health Services Administration}, and 3rd party payers who help fund treatment services.
Patients understand that a well-run treatment clinic offers many benefits. Quality services are only delivered when there is an organizational commitment to helping people while also being able to meet all of the operational requirements such as timely documentation of services (paperwork) and appropriate support of staff & counselors,
Sometimes patients will complain about “so many clinic rules” although many patients appreciate their clinic’s dedication to professionalism and its ability to meet the standards of good quality care. Within most treatment facilities are several key staff who oversee its daily operation and the provision of services. These are the Clinical Director, the Medical Director or primary prescribing physician, the Nurse Supervisor, and possibly clinical staff Team Leaders who do the work of coordinating the clinics many daily activities.
While the list of clinic rules can seem long, there is nearly always an important underlying reason for that rule to exist. Most methadone clinics distribute a Handbook for clients that outlines their rights as an opioid treatment patient as well as guidelines for obtaining dosage adjustments and progressing successfully through treatment.
Opioid treatment, and medication-assistance in particular, must be carefully monitored. This is to insure patient safety and to minimize the risk of medication errors. Please support your local methadone or suboxone clinic with words of encouragement and positive feedback when it is earned. Conversely, it is important to speak up as well if serious problems are occurring. Always make an effort to communicate first with the clinic’s clinical and administrative staff if experiencing a problem. If an honest effort to resolve an issue in this manner is not productive, then contacting one’s local State Methadone Authority is sometimes a logical next step for addressing an important concern.
Several organizations in Ohio recently hosted a town hall discussion on the opioid crisis still occurring there and across the country. News commentator, Eric Bolling, was a moderator of the event which was held at Cedarville University.
Eric and his wife, Adrienne, lost their 19 year old son in 2017 due to an accidental overdose with the powerful opioid, fentanyl.
This town hall discussion was designed to continue raising public awareness on the danger of opioid misuse and the continuing need for treatment and recovery support services to help families deal with this perpetual problem.
The Centers for Disease Control (CDC) report that there were 70,237 drug overdoses in 2017 with 47,600 involving opioids specifically. The article linked above states that the state of Ohio ranked 2nd in overdose deaths only behind West Virginia.
There is promising news in that more Americans are now being educated on opioid risks, and consequently are taking better precautions as well as actively accessing methadone & suboxone programs offering helpful medication-assistance and behavioral counseling. Saving lives and offering recovery are messages that are being heard.
In past decades, opioid addiction was skewed more heavily toward an older generation of adults. But today we have larger numbers of youth using opioids and experiencing addiction-related problems at earlier ages. Importantly, research has demonstrated conclusively that those who remain engaged in treatment for six months or more are much more likely to stabilize and to enjoy sustained success with recovery.
A recent Reuters Health article highlights the fact that many opioid-addicted youth are either not yet engaging in treatment or are exiting treatment too early. While more youth are being saved through the overdose reversal drug naloxone, a majority of addicted youth are still not receiving medicated-assisted treatments such as buprenorphine or methadone.
More work is necessary to open up treatment avenues for young adults across America, and to both educate & compel youth to seek MAT (medication-assisted treatment) as soon as possible.
The opioid addiction problem in America will not soon disappear. Drugs continue to find their way across the U.S. border through multiple avenues. Positive efforts are indeed bringing needed change, but the complexity and extent of opioid addiction in the U.S. will require a long-term, sustained commitment throughout the country. We must get the message out – especially to young people who may not fully grasp the power of addiction!
Opioid Use Disorder is the newer clinical terminology (from the DSM5) used to describe the full range of opioid problems ranging from mild opioid-related use issues to severe opioid addiction.
The CDC reports that in 2017 there were 72,287 deaths from overdose in the United States. That is certainly an alarming statistic. Of that number, 49,060 of those deaths were from opioids specifically – just in 2017. By contrast, there were 58,200 U.S. fatalities that resulted from the entire Vietnam war.
The good news is that government funding for opioid treatment is finally entering the stream on a local level. Increasing numbers of methadone clinics and physicians authorized to prescribe buprenorphine are moving into America’s more rural areas, ones that have historically been severely underserved.
As treatment for Opioid Use Disorder becomes more readily available, people struggling under the constant pressure of addiction will have an opportunity to apply the brake, and to veer onto a new path of stability and recovery. That being said, it is estimated that presently only 1 person of 10 with an opioid use disorder has sought treatment. For many opioid addicted people, treatment made the difference between life and death.
Choose a new path is more than words for those that have truly done so. Addiction is a highly persistent disease, but change is possible. Commitment and action are the necessary ingredients in opening the door to a new life. Opioid Use Disorder, in particular, is successfully treated with medication assistance. Science, research, and life experience have fortunately reinforced this fact with perfect clarity. Please find a local treatment provider today!
A Presidential briefing on March 19, 2018 in Manchester, NH was used to announce that ADAPT Pharma has volunteered to provide, for free, the life-saving medication NARCAN® to all U.S. high schools, colleges and universities.
NARCAN® is a name brand overdose antidote (based on naloxone) that restores breathing and consciousness in opioid overdose victims typically within five minutes.
ADAPT Pharma offers a 40% discount off wholesale pricing on the Narcan nasal spray to Law Enforcement agencies and Firefighters as well as non-profit community based organizations.
Seamus Mulligan, CEO of ADAPT, commented in a company press release that ADAPT is committed to raising awareness of opioid overdose risks and distributing NARCAN® widely so that it will be available to bystanders and emergency personnel who can offer immediate help in the event of a crisis.