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/
Counseling and support services are an integral part of the treatment process. Recovery from opioid addiction involves education on the addictive process and the development of skills that support lifestyle change.
Medication assistance is key in managing opioid withdrawal sickness, but counseling offers the opportunity to learn valuable skills like identifying common high risk triggers for relapse and methods for reducing that risk.
Addiction is a complex illness. Many patients who achieve early stability with methadone or suboxone will relax their commitment to treatment. They let their guard down and begin to take shortcuts. This is a frequent issue in treatment clinics that often leads to relapse.
Sustained recovery from addiction requires a full commitment to change. Individual counseling and group counseling provide the necessary roadmap for staying on the recovery path. Counseling allows patients to achieve a deeper understanding of the challenges they will face as they learn to live drug free.
Opioid addiction can seriously impact a person’s life in many areas, and climbing out of that hole is not easy. Making the correct recovery-based decisions can at times be confusing, and even feel overwhelming. This is where the value of support & input from a counselor, stable friends, and concerned others can make a real difference.
Most MAT clinics and physician practices across the U.S. provide counseling as a component of their opioid treatment program. Participate in these services. These sessions with a therapist or in a counseling group can greatly enhance your ability to stay on course, and ride out the difficult days that you will certainly encounter. There is no replacement for commitment and positive action. These are the foundation of success when true recovery is the goal.
Several articles recently addressed a study which found that providing buprenorphine after an overdose significantly increased the likelihood of individuals accessing opioid use disorder (OUD) treatment.
The current protocol for paramedics and emergency departments in treating opioid overdose is to administer naloxone in order to reverse the effects of overdose. A recently published study showed that also providing buprenorphine immediately afterward reduced withdrawal discomfort and increased outpatient addiction follow-up care.
A separate article referenced data showing a nearly six-fold increase in patients accessing outpatient addiction treatment within 30 days of the overdose event.
These are highly encouraging finds which demonstrate the far-reaching effectiveness of medication-assistance in the treatment of opioid addiction. Saving a life through overdose reversal is obviously a critical benefit, but increasing motivation for follow-up treatment is a huge step in helping addicted individuals plug into a long-term solution.
Structured treatment which utilizes medication-assistance provides so much to those aspiring to face their addiction challenges. Naloxone, buprenorphine, and methadone have saved countless lives, and these medications have provided an unrivaled opportunity for those in opioid addiction to plot a new path in life.
Minnesota officers recently seized a large quantity of fentanyl in the Midwest based on extensive investigation and “very, very good police work”.
The drug bust removed enough fentanyl pills to kill over 1 million people, and the suspected dealer now faces federal charges for possessing a large quantity of synthetic opioids.
Of particular concern was that the fentanyl doses had been pressed into a familiar pill that was indistinguishable from that provided in a typical oxycodone prescription. So oxycodone obtained on the street now presents with a much higher risk of fatal overdose than was previously thought.
The article reported that large quantities of fentanyl continue to come across the U.S. southern border. The U.S. Senate is currently examining how this influx of fentanyl is impacting American communities as drug seizures hit historic levels.
Those currently struggling in active opioid addiction should explore getting professional help as soon as possible. Fentanyl “in disguise” is making its way across the country.
The U.S. Dept. of Health and Human Services has awarded $1.5 billion in an effort to support States in their fight against opioid addiction.
The grant programs will provide funding to increase access to “24/7 Opioid Treatment Programs”. $104 million will be specifically allocated to bring treatment services to rural areas of the country that have been historically underserved.
While stabilizing and rebuilding lives through medication-assisted treatment is a priority, the prevention of overdose deaths is a distinct goal of the new funding initiative. Major confiscation of fentanyl continues month to month as law enforcement authorities intercept huge quantities of the drug pouring across the southern border.
Another $20.5 million is being earmarked for the development of programs that help connect individuals with addiction issues to local community resources that can enhance their overall recovery effort.
Additional focus will be placed on increasing the availability of naloxone which is the emergency medication that can quickly reverse the effects of opioid overdose. Thousands of lives have been saved in the last 10 years through the timely administration of naloxone to those who have overdosed.
The White House report outlines further efforts to disrupt global drug trafficking through the addition of more law enforcement officers.
Providence, Rhode Island is the first location in the United States to offer a mobile methadone service. This article profiles CODAC Behavioral Health who operate a 27 foot RV that has been modified to function as a mobile methadone unit.
The concept behind this innovative approach is to bring essential medication-assisted treatment services to the rural areas of Rhode Island where many prospective patients are underserved.
Access to methadone and buprenorphine-based treatments remains an ongoing challenge as nearly 83% of those with opioid use disorder (OUD) are not yet utilizing medication to help with their opioid withdrawal symptoms. Opioid withdrawal sickness is the primary driver of illicit opioid use, opioid overdose, and lifestyle disruption.
CODAC received their FDA approval in July 2022 to begin dispensing methadone from their mobile unit.
Methadone clinics are a lifesaver for many thousands of recovering individuals across the country. There are a number of new clinics opening each week, but the provision of a methadone mobile service offers an interesting alternative that will be closely watched and evaluated in the years ahead.