The Facts About Suboxone and Opiate Addiction

Combination Drug Can Reduce Withdrawal Symptoms in Addiction Treatment

Suboxone (buprenorphine/naloxone 8mg/2mg) sublingual film. Photograph © Jr. de Barbosa

Opiate addiction is a common problem in the U.S. as evidenced by a 2015 outbreak of HIV in Indiana attributed to the opiate drug Oxycontin. But the use of the drug Suboxone (buprenorphine + naloxone) is making a difference in people seeking treatment for an opiate addiction. 

What Are Opiates?

Opiates are a family of drugs derived either naturally or synthetically from the seed of the poppy plant. They function as narcotic sedatives which depress the activity of the central nervous system, reducing pain and inducing sleep.

Long-term use of opiates, however, can result in an increasing tolerance of the drug, meaning that the amount must be increased to achieve the same effect. In doing so, dependence to the drug developed causing what we commonly describe as an addiction. In some cases, this can lead to accidental overdose and even death.

Some of the most commonly prescribed opiates include:

  • Fentanyl
  • Morphine
  • Vicodin (hydrocodone)
  • Oxycontin
  • Oxycodone
  • Codeine
  • Methadone

In addition, the illegal drug heroin is also an opiate.

The Possible Role of Memory and Triggers

Studies have shown that addictive drugs such as opiates stimulate the chemical dopamine in our brains. In addition to inducing euphoria, dopamine is known to stimulate the memory centers of the brain. Research from the Harvard Medical School suggests that this action can effectively embed the pleasurable affects of the opiate drugs deep in our memory. As such, it can create"addiction triggers" in which any detail of a previous drug episode, however large or small, sparks a sudden craving for the drug.

How Does Suboxone Help?

Suboxone has been approved by the U.S. Food and Drug Administration for the treatment of opiate dependence. It contains two active drugs:

  • Buprenorphine, a partial opioid anagonist, which blocks the opiate receptors in the brain.
  • Naloxone, an opiate antagonist, which blocks the effects of opiate itself.

    While buprenorphine on its own can be addictive, the use of the two drugs in a combined form prevents this since the naloxone component effectively quashes the opiate effects. In short, the brain is prevented from often crushing withdrawal symptoms by satisfying the body's craving for the drug, but is not provided the "high" to reinforced the addictive behavior.

    It's important to note that Suboxone must never be chewed, or crushed and injected. If taken in this manner, the naloxone component can cause severe opiate withdrawal symptoms.

    Suboxone is also available in a sublingual film (shown) which is dissolved beneath the tongue.

    Part Two: Overview of Suboxone Treatment

    Overview of Suboxone Treatment Stages

    Approaches can sometimes vary depending on treatment centers, but there are typically five basic steps in any Suboxone treatment plan:

    • Intake - During this initial part of the plan, your doctor will perform a medical and psychosocial history. Blood tests will be taken to assess organ function, especially that of the liver. A urine drug screen will also be performed as part of your lab work. After this is done, the doctor will explain how Suboxone is used, its potential side effects, and what will be expected of you as a patient.
    • Induction - The goal of this step is to transition you from the opiates you currently take to Suboxone. In order to transition in the most comfortable way possible, you must be experiencing mild to moderate withdrawal symptoms when you arrive fon the day of induction. If none are present, Suboxone can cause intense feelings of withdrawal at the time of your first dose, with the same effect as going "cold turkey."

      Your first dose will be given under the observation of your doctor. Suboxone tablets are placed under the tongue and allowed to dissolve. You should begin to feel better after about an hour. Depending on how well your first dose suppresses the symptoms of withdrawal, a second dose may be given by your doctor.

      The induction phase of treatment can last a day or two to a week in some cases . During this time, daily visits to your doctor are not uncommon. Urine drug screens may be included in these daily visits, as well.
    • Stabilization - It's during this stage that the dose of Suboxone is adjusted to the lowest dose that suppresses withdrawal symptoms. Your doctor will discuss the plan for your recovery, deciding if Suboxone will be used  as long-term maintenance therapy or if it will be gradually tapered and discontinued.
    • Maintenance - For those requiring long-term maintenance, addiction counseling is considered vital.This phase can typically last for months or even a year or more in some cases, under regular medical supervision and ongoing support (e.g., Narcotics Anonymous, non-step support groups)
    • Medically supervised withdrawal - For others, Suboxone treatment will not be prescribed over the long term, but rather tapered gradually over the course of several weeks. The eventual goal is to stop Suboxone treatment altogether, relying on other support mechanisms to sustain sobriety.

    How Do I Get Started?

    Because opiate addiction is both a physical and psychological illness, treatment often requires a multidisciplinary team able to address all of those needs.  If you feel you could benefit from Suboxone, a doctor certified to prescribe the drug can be found at the Suboxone manufacturer website. Addiction treatment programs can also be found by contacting the hospitals or mental health agencies in your area.


    Reuters. "Indiana HIV outbreaks tops 100 cases: state health officials." Issued April 11, 2015.

    Miller, M.; "Addiction and the Brain: Memory's Link to Recovering From Addiction." The Harvard Mental Health Letter; January 2007.

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