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/
The national budget proposal for the 2019 fiscal year includes a request for $13 billion in funding for opioid treatment and related services. This linked Newsweek article states that $3 billion would be allocated in 2018 and another $10 billion in 2019.
Many opioid treatment programs across the country are currently able to add patient slots when additional funding is made available. The opioid crisis has flooded many clinics that are already at maximum census due to limited State and Medicaid funding.
A number of private pay clinics have opened in recent years as the need for medication-assisted treatment increased. If a substantial allocation of government funds becomes available, opioid treatment services will finally come into sharp national focus as scores of people finally obtain the help they need to stabilize and to recover.
In treating opioid addiction, research has shown that traditional abstinence-based programs which do not utilize medication assistance have a failure rate of 90%. Medication-assistance is a critical factor in helping opioid addicted people move into sustained recovery. The proposed $13 billion earmarked for opioid treatment services can make a huge difference all across the U.S. Methadone or buprenorphine (suboxone) coupled with counseling and drug testing comprise the gold standard of care in treating opioid addiction.
There is a great article in the Bismarck Tribune about the expansion of methadone services in Fargo, North Dakota. Fargo, like most other areas of the country, was impacted in recent years by numerous opioid-related overdose deaths.
The article reports that Cass County had 31 overdose deaths in 2016, but that number was reduced to 15 in 2017, due in part to the increased availability of naloxone (the medication that reverses opioid overdose).
While local ambulance calls have decreased in relation to opioid overdoses, the problem of opioid addiction remains a widespread and primary concern in the community.
The Tribune story reveals that more local residents are now enrolled in opioid treatment and are receiving the life-saving medication, methadone. Treatment that combines medication-assistance and counseling is the industry standard in quality care for those addicted to opioids.
The new Fargo-based clinic is reported to have 164 active patients currently enrolled in the methadone program. The clinic director, Mark Schaefer, is quoted as saying that while enrollment has been rapid, there remain many people in the local area with untreated opioid addiction.
The availability of treatment is making a difference. And medications like methadone, buprenorphine, and naloxone are providing a much needed solution to America’s opioid crisis.
The nation’s opioid epidemic has reached fever pitch and is now being spotlighted by all levels of local and national media. This is obviously good news.
At the center of this discussion is what can be done to reduce opioid fatalities, and to provide addicted people a real opportunity to regain control over their lives. This discussion inevitably leads to examining the benefit of medication-assisted treatment.
Methadone and buprenorphine are the two leading alternatives for helping patients deal with the perpetual withdrawal sickness that comes from a physiological dependency on opioids. Naloxone is a medication used to reverse opioid overdose.
In recent congressional testimony to members of Congress, Scott Gottlieb (Commissioner of the FDA) specifically heralded the life-saving benefits of methadone and similar medications.
His testimony included comments on the wealth of information behind the effectiveness of medication-assisted treatment. It is vitally important that legislative decision-makers obtain a clear understanding about what works and what does not in regard to coping successfully with this opioid crisis.
Time is of the essence because the present overdose fatality rate in the United States is over 64,000 per year. This number is beyond alarming. Here is an article that points to a possible positive shift in communities’ openness to having local opioid treatment nearby. Hopefully, this becomes a trend.
Opioid addiction is one of the more challenging substance use disorders to confront and manage because of its physical dependency characteristics. Once the process of physical addiction has taken hold, avoiding daily withdrawal becomes a high hurdle.
Because of this daily dilemma, it becomes difficult to remain focused on other aspects of recovery. It’s the law of “first things first” that applies when tackling any problem. There is a natural order and sequence which must be followed when trying to solve a complex task. Opioid addiction recovery is no exception.
Obtaining relief from opioid withdrawal symptoms is a very important first step in addressing opioid addiction. This is why medication-assisted treatment is specifically identified as a medical best practice. Science and years of exhaustive research have proven (not just suggested) that treatment coupled with medication-assistance offers the greatest probability of long-term success when trying to overcome moderate to severe opioid addiction.
Fortunately, more people are becoming aware of the need for buprenorphine, methadone, and other medications that can play a vital role in stabilizing an opioid addicted individual at the onset of their personal recovery.
Historically, efforts to come off of opioids in a detox setting have been often unsuccessful because many detoxes used insufficient medications to alleviate withdrawal symptoms. Consequently, patients would typically begin to get sick in 1-2 days with their withdrawal symptoms becoming intolerable. This can lead to patients abandoning the detox effort and a quick return to illicit opiates.
However, the tide is turning. As the American opioid crisis continues to impact families and U.S. society, many more physicians, lawmakers, and government representatives are gaining a quick education on the enormous value of medication-assisted treatment. Methadone is at the forefront of this new awareness as is buprenorphine-based products like Suboxone.
Appropriate medications used responsibly and under a doctor’s supervision provide stability, hope, and opportunity.
Imagine trying to medically manage advanced diabetes with no insulin or grand mal seizures without anticonvulsant medication.
Modern medicine has raised our standard of living and sustained life in ways that people could not have imagined just 100 years ago.
In the cases cited above of diabetes and epilepsy, medication functions as a miracle intervention that saves the patient from suffering and death, and allows him or her to lead a full and productive life.
Science is clearly instructing us that addiction is a treatable illness which can at times be successfully managed with medication assistance, similar to the stabilizing role that insulin plays in the life of the diabetic patient.
A critical element of opioid addiction is the physical dependency which leads to debilitating opioid withdrawal symptoms. For many individuals, the persistence and severity of opioid withdrawal leads them to chronic failure in any effort to recover. With the assistance of methadone (or buprenorphine), many of these people will finally be able to cope with their illness by having their withdrawal symptoms alleviated.
The value of relief from opioid withdrawal is monumental. It is often the first major step toward being able to face one’s addiction. Medication assistance is good science, and it opens a door that was likely closed for many years. The value of having a new start is priceless. We only have one life. It is worth saving. Whether it’s diabetes, epilepsy, heart disease, or addiction – specific medications can help a patient restore their quality of life.