Methadone and suboxone 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's most common formulations are a tablet or thin film, both of which are 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 tablet.
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 mg of medication daily. 24 mg is generally considered to be the dose at which maximum withdrawal relief is provided. For most addicted people, taking more than 24 mg of suboxone 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 24 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/
Suboxone is medically approved to treat opioid addiction and withdrawal in the United States, and opioid replacement therapy is a documented, evidence-based best practice. That being said, the city council of Bangor, Maine voted 7-2 against the expansion of opioid treatment services in Bangor that would allow existing treatment programs to offer additional Suboxone (buprenorphine) services to addicted people seeking treatment.
Council members were quoted as saying that Bangor had done more than its fair share of helping the addicted population, referencing the fact that many people travel from outside the area to participate in one of Bangor’s three opioid treatment programs.
This moratorium on expanding Suboxone will leave many to struggle with their severe addictions while viable opioid treatment services could be made available to help them. However, the Council wanted more time to consider whether the expansion of opioid treatment would be a good idea for the city. The temporary ban generated considerable dissension once again showcasing that … Read more
When a new client joins a methadone program, they go through a process called induction. Induction is the initial delivery of a methadone dose and the subsequent increases in dosage over the next 1 to 2 months as the medical team help get the client stabilized & comfortable on a dose of methadone that effectively eliminates their painful opioid withdrawal symptoms.
Induction is historically a high risk span of time since there is an increased risk of accidental overdose with methadone. It is extremely rare that overdose occurs during induction especially if clients are abstaining from other illicit substances during the induction process.
Therein lies the dilemma. Some clients become impatient with the process of methadone induction and will supplement their methadone dose with other unapproved opiates or benzodiazepines. This is dangerous and actually undermines the benefit of what methadone can achieve for the patient.
To help the treatment team determine the level of methadone increase to provide a … Read more
The U.S. has experienced a steady rise in the number of people being prescribed opioids and in the number of individuals becoming physically addicted to these medications. In the 1970′s and 1980′s, the typical methadone program client was someone who had graduated to daily IV heroin use.
Fast forward to 2013 and the typical methadone program participant may well be someone who has never used heroin or any kind of injectable drug. With the rise of oxycontin over a decade ago and other popular painkillers, opioid addiction in America moved to unprecedented levels. With this new epidemic level of opiate addiction has come an increasing number of overdose deaths.
Within the last 10 years, Tennessee was for several of those years the nationwide leader in the number of prescribed opioids per resident and the number of opioid overdose deaths. Many of these fatalities were the resulting combination of mixing opioids with benzodiazepines like xanax, klonopin, and ativan. Today, many opioid … Read more
Many clients in methadone programs have co-occurring disorders like depression, anxiety, or adult attention deficit disorder (ADD). Historically, clinics have attempted to treat psychiatric symptoms with established, FDA-approved psychotropic medications which have proven useful across many settings in managing symptoms.
In the past decade, it became very apparent that benzodiazepines (commonly prescribed to treat anxiety) had become a popular alternative drug of abuse for individuals with an opioid addiction. “Benzos” are a particularly dangerous medication when used in conjunction with methadone, and the combination of these two contributed to a number of overdose deaths in recent years.
For this reason, many safety-oriented, reputable methadone clinics (and independent physicians) either discontinued or noticeably restricted their use of benzodiazepine medications with patients on methadone. Common benzodiazepines include prescription meds like klonopin, valium, xanax, and ativan. As an alternative to these high risk medications, non-addictive options like Buspar are utilized to help clients better manage their anxiety symptoms as well as cognitive therapies … Read more
An article was brought to our attention by Dr. Dana Jane Saltzman, a New York City physician who specializes in the treatment of opioid addiction. Dr. Saltzman uses suboxone in her private practice to help those seeking recovery from a severe opioid habit.
The article was posted in The Village Voice and attempted to depict the duality of opioid replacement therapies. This duality stems from the highly therapeutic & legitimate uses of suboxone (buprenorphine) contrasted against the attempts of some addicts to create a black market cottage industry with the medication selling it illegally online via Craigslist, Facebook, and other social media.
In the world of medicine and addiction treatment, selling suboxone is certainly criminal, and also behavior characteristic of someone who is not grounded in recovery. Many medical & clinical treatment professionals across the country have endeavored for decades to provide safe, effective treatment to suffering addicts. When FDA-approved opioid treatment medications are misdirected and sold on the black … Read more
To be curious is a basic part of human nature. We live each day naturally drawn to things which interest us, which feel good physically or emotionally, or which might incite some curious inclination down inside of us. It is literally wired into the human DNA to be inquisitive and to seek new experiences.
We live in an information age in which most anything one wants to know is available via the internet. We know that drugs are dangerous. Yet, we naturally assume substance problems are something that happens to someone else. We know that addiction is real and can wreck one’s life, but we look past the potential danger and conclude that these risks don’t really apply to us at this time, or in this particular situation.
There is an old saying in recovery circles that no addict started out with the intention to become addicted. This is, of course, true. No one starts out intending to become an … Read more