Opioid addiction treatment with suboxone (buprenorphine/naloxone)
The Drug Addiction Treatment Act was passed by Congress in 2000 allowing qualified physicians to treat opioid addicted patients with specifically approved narcotics in settings other than traditional treatment centers, e.g. methadone clinics. Sublingual buprenorphine was approved for use at this time and has since become a major drug of choice in the effective outpatient treatment of opioid addiction.
How does Suboxone work?
Strong opiates, such as morphine, work by temporarily attaching to receptors in the brain that stimulate the release of dopamine producing a short-lived euphoric feeling. Once the opiate detaches from these receptors, the patient begins to experience strong and long-lasting withdrawal symptoms that include cravings and an urge to repeat the experience. Suboxone, a combination of the drugs buprenorphine and naloxone, works by firmly attaching to the receptors thus blocking the opiates from attaching. Buprenorphine is a partial opioid agonist which produces a very limited opiate effect - enough to stop withdrawal but not enough to cause euphoria. It is long acting, continuing to block other opiates from attaching to the receptors for a period of 24-72 hours after a simple dose. Naloxone is an opioid antagonist which also competes to block the opiate receptors but without producing any opiate effects.
The first dose of Suboxone is given in the office. Initially the patient may be seen often over several days in order to assess symptoms and to adjust the dosage. Once the most effective dose is established, the patient begins the maintenance phase of treatment and is considered stable. Patients are carefully monitored for withdrawal symptoms and frequent urine tests are obtained to verify the absence of opioids in their system and compliance with treatment.
How long will I stay on Suboxone?
It is up to you and your provider to determine the length of your treatment course. The degree of physical dependence, psychological and behavioral components all play a role in opioid dependence and affect the duration of treatment. There is concern that short-term treatment does not allow for the behavioral changes necessary for maintaining an opioid-free lifestyle. Support, counseling, and suppressing cravings for as long as necessary are each important elements in the successful treatment of dependency.
Once it is determined by you and your provider that you no longer need Suboxone, your dose may be slowly tapered until you are no longer taking any medication. Abruptly stopping the Suboxone will very likely result in some mild withdrawal symptoms.
What determines successful treatment?
Open and honest communication between the patient and the healthcare team is important to optimize the success of treatment. Our providers and nursing staff have been specially trained to understand opioid addiction and the nuances of how best to treat dependence. It is imperative for safety that you follow specific guidelines and instructions while in treatment. Your doctor may also prescribe other medications to help control addiction symptoms.
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