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/
While it is fairly common knowledge these days, it bears repeating that fentanyl is leading to dramatic increases in drug overdose deaths. The Families Against Fentanyl group, using three years of CDC mortality data, recently concluded that fentanyl overdose had caused more deaths than the corona virus, automobile accidents, or suicide in the 18-45 age group.
Fentanyl is finding its way into other dangerous street drug combinations, and is consequently posing serious risks to both experienced and unexperienced users.
A December 2021 Wall Street Journal article mentioned that there were 100,000 fatal overdoses in the United States between April 2019 and April 2020. Fentanyl is making its way across the U.S. southern border smuggled in by Mexican drug cartels in a stream of drug trafficking that is yielding a constant challenge to U.S. law enforcement authorities.
Fortunately, community-based drug prevention programs across the country have begun including extensive discussions of the dangers of opioids and fentanyl as a common additive.
Opioid addiction in America will remain a chief concern for many more years to come. Securing local treatment and support has never been more important than it is right now.
The faces of recovery are as diverse as you can imagine. Decades ago, there were common stereotypes of addicts as people who looked a certain way and likely came from a shady side of the tracks.
Today, we now understand that addiction has impacted nearly every family and community across the country. It has crept into mainstream life to such a large extent that the old stereotypes have faded away, and in their place are pictures of everyday people like the ones we know and love.
Opioid addiction is an illness that can be successfully treated. This new reality provides hope and assurance that nearly any person, with proper support and treatment, can successfully manage this illness and regain their life.
However, the odds are not good for individuals who stay in active addiction and who postpone their entry into professional care. With the widespread proliferation of fentanyl and other adulterated street opiates, the risks have never been greater.
In the United States, there are a significant number of methadone clinics, buprenorphine clinics, and qualified physicians who specialize in the treatment of opioid addition using medication-assisted approaches. For the vast majority of opioid addicted people, medication is key in helping them to prevent extremely diffcult opioid withdrawal.
Once withdrawal sickness is effectively eliminated, then counseling & support can help restore a person’s life and open up new paths to the future.
The science of treating opioid addiction has become increasingly popular in both medical circles and in the addiction treatment community.
For decades, medical professionals and even popular recovery organizations did not quite understand how giving an opioid addict a replacement medication could actually facilitate recovery.
Part of the dilemma was that those who defined “recovery” did so using an old school philosophical approach originally crafted for alcoholism. But science has taught us that not all addictions are exactly the same. While there are certainly commonalities between the various substance use disorders, there are very important distinctions and differences which affect the recovery process.
You cannot prescribe a medication that is effective with depression, and expect that same medication to resolve schizophrenia or an anxiety disorder. While they are all mental health disorders that can debilitate a patient, there are critical differences between these disorders and in the overall treatment plan for addressing each one.
Similarly with addiction, science is teaching us that a one-size-fits-all approach to addiction recovery is detrimental and often unproductive.
With opioid addiction in particular, the disease progression is quite unlike most other addictive illnesses. While the medical profession has evolved that understanding, the recovery community and general society has at times struggled to comprehend the necessity of medication-assisted treatment for the opioid addicted.
Physicians, Nurse Practitioners, PA’s, Nurses, and Counselors all play a part in educating patients, their families, the community, and government on the key role that medication plays in the successful management of an opioid use disorder. Methadone, subutex, suboxone, vivitrol, and other medication choices make the difference between recovery success and repeated recovery failures.
Various news outlets are reporting new statistics which indicate deaths from opioid overdose are beginning to go down.
The Associated Press reports that for the first time in a decade overdoses among New York residents (outside of NYC) have declined 15.9%. Government officials are quoted as saying that about 80% of the overdose deaths were attributable to heroin or fentanyl.
The AP cited a new CDC (Centers For Disease Control) July 2019 study which showed overdose deaths in 2018 fell for the first time in nearly three decades.
Various public education efforts and New York’s Opioid Task Force are thought to be significant catalysts for the slowdown in opioid overdoses. The availability of naloxone has also been highly instrumental in impacting overdoses nationwide with many communities across the country now providing naloxone kits for free.
A number of metro areas in the U.S. are also examining the feasibility of mobile opioid treatment since transportation to clinics or physicians is often an impediment to accessing medication-assisted treatment resources.
Behavioral Health Group (BHG) currently provides 58 top flight opioid addiction treatment centers in the United States. The company specializes in medication-assisted treatment using methadone, buprenorphine, and buprenorphine/naloxone.
BHG takes a patient-centered approach to treating addictive disorders offering counseling as a fundamental component of the overall treatment model. Because of this individualized treatment approach, 97% of patients surveyed indicate they would recommend BHG Recovery to a friend or family member suffering from opioid addiction.
Additionally, 99% of patients report that their mental health and quality of life improved since their BHG admission. 60% of unemployed patients were able to obtain employment after one year of treatment.
Hope, Respect, and Caring are tenets of BHG’s treatment program, and their staff strive to provide this from the moment a patient first walks in to receive help. All of BHG’s treatment centers provide care in an outpatient setting.
In 2019 and 2020, BHG Recovery added (10) additional U.S. clinics to the Methadone.US national directory list …
1. Franklin, VA – BHG Franklin Treatment Center