What is Suboxone?

  • It is a combination of two synthetic opioids
    • Buprenorphine: a partial opiate receptor agonist and is the more active component of Suboxone.
    • Naloxone: an opiate receptor antagonist (it is included in the formulation to prevent abuse)
  • It acts as a partial agonist with respect to respiratory depression. As such, it is a very safe medication.
  • It has a ‘Ceiling Effect’ in that increasing the dose past a certain point will not cause an additional effect.
    • All the opioid receptors will be occupied yet they are still only partially stimulated.
    • Therefore, it is much more difficult to cause respiratory depression (and death), compared to other opiates, even when suboxone is taken in excess.
  • It acts as a full agonist with respect to treating pain. As such, it is as good as other opiates for treating pain, however, in order to do so, Buprenorphine would have to be taken 3-4 times daily.
  • It binds very tightly to the opiate receptor. This is particularly useful with regard to treating addiction.
  • If a patient on Suboxone attempts to continue abusing opiates they will have very little or no effect.
    • In other words, the patient will not get ‘high’ off of opiates of abuse.
    • This ‘negative reinforcement’ of drug use usually results in the patient discontinuing opiate drug use very quickly.


Suboxone

"When you can stop, you don't want to, and when you want to stop, you can't..."

                                                                                                                                                 -
Luke Davies

​How is pain treated if I’m taking Suboxone?

  • Suboxone has been shown to be very effective in treating pain, however, it needs to be taken 3-4 times daily for that purpose.
  • If one suffers acute pain while on Suboxone and your Family Physician or Dentist prescribes an opiate its effect will likely be blocked by Suboxone. As such, a higher dose of opiate may need to be prescribed.
  • If you are prescribed opiates from another physician, be it your Family Physician, Dentist, or any other physician, please inform your Suboxone prescriber.


Will I become addicted to Suboxone?

  • Patients taking Suboxone are already physically dependent to opioids – stopping it will cause the uncomfortable physical symptoms of withdrawal.
  • However, by definition, these patients are not addicted to Suboxone even though they are physically dependent – addiction involves not only a physical need for the drug (dependence) but several undesirable behaviours that a person develops to help them get the drug.

How does the Suboxone Program Work?

  • If a patient decides to start on the suboxone program they have to abstain from opiate use for 24 hours before starting. The patient must be in mild to moderate withdrawal before Suboxone is administered.
    • The reason for this is due to the high affinity of buprenorphine (Active component of Suboxone) to the opiate receptor.
    • It binds very tightly to the receptor such that if there are any other opiates in a patients system the buprenorphine will displace them off the opiate receptor.
    • The partial agonist properites of buprenorphine only partially stimulates the receptor. This leads to the rapid development of withdrawal symptoms – a complication known as precipitated withdrawal.
    • If you are in mild to moderate withdrawal before starting Suboxone it will start working right away and you will soon feel better. If you are not withdrawal, starting Suboxone may make you may feel worse. Therefore, it is important for you to tell your physician if you have used opiates in the previous 24 hours.
    • Starting Suboxone is termed an Induction and should only be attempted by a physician trained in the procedure.
  • Before induction, your physician will ensure you are in  opiate withdrawal.
    • Your physician will then administer a test dose of Suboxone and have you wait in the clinic for at least one hour. After which, the physician will reassess you to make sure you haven’t gone into the precipitated withdrawal discussed above. If you are fine then the remainder of the starting dose of suboxone will be administered.
  • The administration of Suboxone is sublingual. The buprenorphine component is not effective if the pill is swallowed, only if it is allowed to dissolve and absorbed under the tongue.
    • NOTE: The naloxone component of Suboxone is only active if the pill is liquefied and injected – taken in this way naloxone blocks any effect buprenorphine (or any opiate) would have. This is a safety feature and prevents abuse.
  • A patient will reach a stable dose of Suboxone within 24 hours to a few days (compared to a few weeks with methadone).
  • Similar to the Methadone Program, patients must initially go to a pharmacy every day to get their dose. The pharmacist will witness the doses being taken.
  • As they progress in the treatment program patients will be allowed to have take home doses (carries) to take on their own. This will be based on stability, abstinence from drug use, and in consultation with their physician.
  • The Suboxone program follows similar rules with respect to clinic visits, urine testing and granting of carry home doses as the Methadone program, however, the Suboxone program is probably easier than the methadone program with respect to how quickly take home doses are granted and travel allowances.

Can I take Suboxone if I’m pregnant?

  • Suboxone is NOT currently approved for use in pregnancy.
  • However, it is interesting to note that the active component of Suboxone, buprenorphine, IS safe in pregnancy.
  • The concern over Suboxone in pregnancy is related to the Naloxone component which in studies on rats has been linked to fetal death.
  • This risk may be overstated but if you become pregnant while on Suboxone your physician will switch your therapy to Buprenorphine alone (Subutex) or if necessary to methadone.
  • The preference is to switch to Buprenorphine (Subutex) since Neonatal Abstinence Syndrome (Opiate withdrawal in an infant) is less severe and requires less treatment in babies born to mothers on burpenorphine rather than methadone.


How much does Suboxone cost?

  • Suboxone is covered under most drug plans. It is also covered by the provincial drug plan in Ontario (ODB).

FAQ’s

How long does a dose of Suboxone last?

  • Depending on the patient the half life of Suboxone can be as long as 72 hours. It is therefore useful to prevent withdrawal because of this long duration of action.
  • For most patients a single dose prevents withdrawal for more than 24 hours.


Is it possible to get off Suboxone?

  • It is possible to taper off suboxone, but only in consultation with your physician and only when you are clinically stable and have been abstinent from drug use for some time.
  • By slowly decreasing the dose over weeks or (More typically) months patients can taper off Suboxone without having to go through withdrawal
  • Patients at Vista Health Clinics will never be forced to taper off Suboxone. Many patients prefer to stay on Suboxone long term.


What are the effects of long term Suboxone therapy?

  • Suboxone is very safe medication when taken as prescribed. It is not known to cause long-term damage to organs, even after years of use.
  • Elevation of liver enzymes can occur in some people, however, this usually reverses once the drug is discontinued.