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Opioid addiction is considered an epidemic in the US. According to the American Society of Addiction Medicine, drug overdose is the leading cause of accidental death in the country, and overdoses on opioid prescription medications, like hydrocodone, oxycodone, and morphine, as well as heroin, are causing these deaths. In 2014, there were an estimated 21.5 million Americans ages 12 and older who suffered a substance use disorder of some type; 1.9 million of those people struggled with addiction to prescription narcotic painkillers, and 586,000 struggled with addiction to heroin.
Helping people overcome addiction or substance abuse is extremely important, and because of the large number of people suffering due to the opioid epidemic, a great deal of focus has turned to developing medications to help those struggling with addiction to prescription painkillers, heroin, and other illicit narcotics. For decades, the primary medication used to treat people suffering heroin addiction was methadone, but in recent years, types of buprenorphine have become more popular in the United States. In 2002, the Food and Drug Administration (FDA) approved Subutex and Suboxone, two buprenorphine formulas, for outpatient treatment of addiction to narcotics. These two drugs are different but share some similarities, and both have a potential for addiction and abuse.
Buprenorphine is the current preferred generic prescription drug used in medication-assisted treatment, or MAT. The goal with buprenorphine medications is to replace a person’s drug of addiction, whether it is a medication like Percocet or an illicit drug like heron or fentanyl. The drug binds to opioid receptors in the brain to ease withdrawal symptoms for up to 24 hours, depending on the formula. The physician who prescribed buprenorphine will work with their patient to gradually taper the dosage.
Buprenorphine can also be prescribed and dispensed at physicians’ offices, as long as they receive specific training and federal approval. This is a vast improvement compared to methadone clinics, which had struggled with being overwhelmed by patients.
There are several brand names of buprenorphine medications, but two of the original medications in the US are Subutex and Suboxone.
Subutex was one of the original formulations of buprenorphine, and it does not contain any other active ingredients. Due to abuse potential, however, Subutex was taken off the market in the United States in 2011.
When available, Subutex was prescribed as a sublingual tablet. As pure buprenorphine, Subutex was believed to be better for patients during the first few days of opioid addiction treatment, as more of the medication would be available after ingestion. This initial treatment period is, according to FDA information on Subutex, called induction, and a patient must go to the doctor’s office to receive their medication.
Although pure buprenorphine does not induce intense euphoria at prescription doses for people who have become physically tolerant to other opioids, it can induce euphoria in people who have never ingested opioid drugs before. Subutex was often crushed and snorted, in order to bypass the slow-release design when ingested orally and processed through the digestive system. This bypassing allowed the person abusing their medication to get a “rush” as the drug passed rapidly into the brain through the bloodstream.
It was rare, but it was possible to suffer overdose on buprenorphine or Subutex with these abusive behaviors. Becoming intoxicated on Subutex could also lead to side effects, which ranged in severity, including:
Suboxone combined buprenorphine and naloxone. When prescribed in combination with Subutex, Suboxone was a later medication used to continue tapering the individual off opioid drug abuse.Naloxone is a drug that stops the brain’s opioid receptors’ uptake of narcotics and binds there instead, without creating any euphoria or side effects. It simply blocks the uptake of drugs, and it can be used to temporarily stop an opioid overdose. However, naloxone does not last very long in the body, so during an opioid overdose, emergency medical attention is required, whether naloxone has been administered or not.
The addition of naloxone to buprenorphine was intended to reduce Suboxone’s potential for abuse. The pill form of Suboxone also no longer exists on the US market, removed in 2012 due to some people abusing the drug by bypassing the naloxone when possible. This was attempted by taking large doses by crushing the pills and snorting or injecting them. Although naloxone should have blocked any intoxicating effects buprenorphine could have in these methods of ingestion, rushing the brain with buprenorphine and waiting until the naloxone wore off could lead to intense intoxication and overdose.
Suboxone is still available in dissolvable filmstrip form, and many physicians believe that, for most people attempting to overcome opioid addiction, it is a less abuse-prone prescription to ease withdrawal and end physical dependence. However, people who have no tolerance or greatly reduced tolerance to narcotics can still get high off Suboxone despite the naloxone addition.The FDA notes that chronic ingestion of nonmedical doses of Suboxone will produce dependence, similar to other narcotics.
Side effects associated with Suboxone abuse are similar to those of other narcotic drugs and Subutex.They include:
Buprenorphine medications like Subutex and Suboxone were designed to treat people struggling with addiction to other narcotics, like hydrocodone or heroin. Unfortunately, these medications have been diverted and sold illicitly as drugs of abuse themselves. Some formulas, like Subutex, have been completely removed, while Suboxone and other buprenorphine combinations remain on the market, with attempts to reduce their abuse potential.
People who struggle with buprenorphine abuse must inform their doctor if they received this medication as a prescription to overcome addiction to other narcotics. If a person purchases buprenorphine medications illicitly, with the specific intention of getting high, they should find a doctor or treatment program to help them taper off the drug and end physical dependence. Medical detox is recommended for opioid withdrawal, and it might involve small doses of antidepressants and over-the-counter painkillers to reduce withdrawal symptoms. After withdrawal, a comprehensive addiction treatment program should follow to ensure a full recovery.