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, Reckitt Benckiser. 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/
It was announced in June that North Dakota would be receiving its first methadone clinic. North Dakota and Wyoming are the only two states in the U.S. that have yet to provide a methadone treatment program for opioid addiction.
The region has suffered in recent years with an increase in the use of heroin and fentanyl, and with associated opioid overdoses. Kurt Snyder is the Executive Director of the new clinic, Heartview Foundation. Mr. Snyder echoed the research-based evidence showing that medication-assisted treatment for opioid addiction provides superior results to abstinence-only treatment interventions.
In the article linked above from The Jamestown Sun, a local police detective indicated that the addiction problem had recently worsened in North Dakota as a result of the price of drugs dropping.
The Heartview Foundation clinic will also offer buprenorphine and naloxone in addition to methadone thus providing a more complete range of medication assisted therapies. Therapeutic counseling and mental health treatment will be a component of the Heartview program as well as drug testing.
Of particular benefit too is the recent initiative in North Dakota that will allow pharmacists the ability to prescribe naloxone so that opioid overdoses can hopefully be greatly reduced. The ready accessibility of naloxone is receiving a nationwide push as communities struggle to address overdose concerns.
Methadone.US welcomes a new addition to the featured clinics here on the site with the listing of BrookStone Medical Center in St. George, Utah.
The FDA has approved a new implantable drug called Probuphine. Probuphine contains the partial opioid agonist, buprenorphine, which is used to suppress the opioid withdrawal symptoms that interfere with daily life.
The implant is the size of a matchstick and is inserted under the skin in the forearm area. It steadily releases a dose of buprenorphine which has been scientifically proven an effective treatment for eliminating opiate withdrawal symptoms in a number of people physically dependent on opioids.
With heroin and opioid overdose deaths at an all time high in the United States, this new alternative offers one more beneficial path for anyone struggling with opioid relapse and chronic withdrawal. Importantly, Probuphine only treats the physical withdrawal from opioids such that the underlying psychological factors of addiction must still be treated through counseling and other support approaches.
The Wall Street Journal has an extensive article on this new medication and the historically important role of methadone and oral buprenorphine. In the article, Nora Volkow (director of the National Institute on Drug Abuse) is quoted as saying:
Over 47,000 people died in the U.S. of drug overdoses in 2014. A majority of these were attributed to heroin and prescription painkillers. With continued coverage in the media and ongoing community discussion, more answers and helpful interventions will hopefully see the light of day.
President Obama recently attended the National Prescription Drug Abuse and Heroin Summit in Atlanta, Georgia. Professionals and concerned citizens used the forum to explore ways to address America’s rising opioid addiction problem.
The President agreed that increased funding is needed to raise access to drug treatment in an effort to simply avoid incarcerating those addicted to heroin and other potentially deadly opioids.
The NBC article referenced here states that over 28,000 people died last year from opioid overdose in the United States. This number has quadrupled since 1999. Many of the overdoses occur from various opioids laced with a powerful prescription pain killer called fentanyl.
Methadone and buprenorphone (the active ingredient in suboxone) are the leading medications used in medication-assisted treatment approaches. Naloxone is another important medication which has been used to reverse opioid overdose. It has saved thousands of lives and is being widely adopted by first responders and police departments across the country due to its proven effectiveness.
President Obama expressed that the U.S. will move toward improved drug treatment access for opioid addicted individuals and that the issue of addiction will be dealt with more as a public health issue as opposed to strictly a criminal act. Included in the proposed legislation is doubling the patient limit such that doctors can treat up to 200 people with buprenorphine (suboxone). The current patient limit is 100.
The Department of Health and Human Services is reported to have committed another $94 million to community health centers to boost their provision of medication-assisted treatment in poor and isolated communities. Many rural areas of the U.S. have very limited availability of opioid addiction services.
PBS’ Frontline series of specials just aired a compelling documentary by the name of Chasing Heroin. The two hour investigation profiles a number of individuals who became addicted to opioids, some of whom chose methadone or suboxone to help them successfully manage their addictive disorder.
The documentary highlights that addiction is best addressed as a medical illness instead of a punishable criminal act. There is widespread consensus today that putting large numbers of people in prison for drug use has not been an effective approach to the problem of drug addiction.
Incarcerating users is very costly and ultimately does not lead to remaining drug free once released from prison. For those suffering with a chronic opioid addiction, medication assisted treatment has become the standard of care proven to be most effective – particularly for those individuals who have tried others forms of treatment that did not work.
The Frontline documentary linked above is very informative, but please be forewarned that it does display vivid scenes of drug use that some viewers may find disturbing. So please exercise appropriate caution before viewing.
NBC News recently reported on the heroin crisis that New Hampshire residents have witnessed. Unprecedented numbers of people from all age groups are struggling with opioid addiction. Many are now deceased with estimates putting the number at nearly 400 who died from a fatal overdose just last year.
New Hampshire is reported to have no state-funded methadone programs to assist those experiencing severe heroin and other opioid addiction. There are several private clinics, but those are currently full with waiting lists for individuals who hope to one day be admitted.
Diane St. Onge, director of the Manchester Comprehensive Treatment Center, is quoted as saying “We need more treatment options. People’s lives are at stake.” Her clinic is presently operating at capacity with 540 patients according to the NBC article. Scores of untreated addicted adults are seeking treatment. When clinics are at capacity, they are forced to place prospective patients on a waiting list.
It is estimated that a significant number of the overdoses are related to heroin and other opiates being mixed with fentanyl and other substances. This makes the potency of the drugs being used almost impossible to predict thus greatly increasing the chance of accidental overdose.
Detox or medication-assisted treatment are the primary modes of intervention for those with opioid addiction. While there has been a substantial increase nationwide in the number of clinics dedicated to treating opioid addiction, there remain numerous areas throughout the country where methadone and suboxone support services are not yet readily available.