Addiction has always been a part of human society and it has interested scholars for generations. With the advancement of technology and medicine in the developed nations of the world, it has become possible to ascertain the underlying mechanisms behind addiction and some of the best treatments to help those struggling with the affliction. New drugs are constantly being formulated in pharmaceutical laboratories around the world, and some of these drugs have helped combat the debilitating effects of substance dependence.
Suboxone, otherwise known as buprenorphine, is a semi-synthetic opioid that is primarily utilized to treat opioid dependence in dosages equal to or greater than 2 mg. It has also been readily used for patients with moderate pain levels and no tolerance to opioids at a dosage of approximately 200 micrograms. In some settings, it can even be used with patients who are chronically affected by moderate pain at dosages between 20 to 70 micrograms per hour.
Buprenorphine can be obtained in various forms, including Suboxone, Subutex, Temgesic, Zubsolv, Buprenex, Butrans and Norspan. Each form has a distinguishing factor that is related to what it is being used for and how it is administered. For example, Buprenex is a liquid solution of buprenorphine that is utilized in primary-care setting for acute pain and it is administered intravenously.
For the most part, this drug comes in the form of either a tablet form or a sublingual strip that dissolves under the tongue. In the United States, the predominate purpose of prescribing Suboxone is for long-term replacement therapy and detoxification from opioids. The drug is also used for the same purpose throughout the European Union (EU), but recreational use of the substance has engendered concerns among some of the EU nations.
First, buprenorphine is widely used for the treatment of moderate to severe chronic and acute pain. When used for chronic pain, Suboxone is usually administered using a transdermal patch, much like the nicotine patches used to ween from nicotine. The patches provide a slow release to treat the pain over a predetermined amount of time. When patients undergo an operation, the intravenous solution of buprenorphine is usually used to treat the pain, as opposed to morphine.
Although the sublingual formulation of Suboxone is not available for the use of treating pain in the United States, it is sometimes prescribed in order to transition off of the aforementioned transdermal formulations. In other settings, it may be suitable to prescribe the sublingual formulation when all other treatments are found to be unsuitable, but usually only in cases where Suboxone is the only drug therapy that the patient is involved in. These cases usually include patients suffering from an obstruction of the small bowel, malignancy in the neck or head, oesophageal fistula, continuous nasogastric suction, and the inability to swallow.
Suboxone is readily used to treat chronic pain, because of its relatively long half-life and the numerous options for administering the drug. Other advantages include: the lack of immunosuppresive effects, a ceiling effect for respiratory depression, no accumulation in renal impairment and a low potential for pharmacokinetic interactions among other drugs.
Additionally, Suboxone has the potential to help patients with chronic pain be able to sleep, because it has the effect of inducing sleep. Patients with chronic pain are also subject to depression, so the euphoric effects of Suboxone can act as an antidepressant. Patients with anxiety may also find relief from Suboxone, because of its anxiolytic effects.
Finally, Suboxone is used to treat patients suffering from opioid dependence. Because of its relatively long half-life, Suboxone last longer within the body. Thus, it is possible to ween opioid dependent patients by decreasing the dosage by the necessary increments over a predetermined time period. With its long-lasting effects, Suboxone serves to virtually annihilate any and all withdrawal symptoms for opioid addicts.
As noted before, Suboxone’s primary use is for the treatment of opioid dependence, but how did it come to be that way in the first place? Suboxone was first synthesized in the late 60s when a British pharmaceutical company was looking to produce an over-the-counter analgesic that would serve to treat pain while also proving to be non-addictive. By 1971, the first human trials were conducted, and it showed promise with a low addiction potential and a high affinity for treating pain.
When the drug first hit the markets in 1978, it was primarily used intravenously to treat severe pain, but the sublingual formulation quickly followed in 1982. In the United States, the sublingual formulation of Suboxone was approved by the Food and Drug Administration (FDA) for the treatment of opioid dependence in 2002. That same year, any products containing buprenorphine were classified as a Schedule III controlled substance by the Drug Enforcement Agency (DEA).
Prior to the year 2000, only opioid treatment programs were allowed to prescribe Schedule III narcotics for detoxification and the treatment of addiction. After the Drug Addiction Treatment Act passed, it was made possible for physicians to prescribe and/or administer Suboxone, if they were properly trained. The first treatment program that utilized buprenorphine for opiate addiction was founded at Columbia University and had an 88% success rate.
Through opioid replacement therapy, a number of beneficial consequences have resulted for society as a whole. For one, opioid replacement therapy has assisted hundreds of thousands of American citizens in the reduction of relapses to illicit opioids and the financial costs to society that go along with criminal behaviors and prevention. Also, opioid replacement therapy has done a number on the spread of certain communicable diseases, such as HIV and Hepatitis C.
Suboxone has proven to lower incarceration and recidivism rates for drug related crimes. The use of Suboxone has allowed opiate addicts to bypass the regular need to obtain illicit opiates to fend off opiate withdrawal and reintegrate themselves back into society as law-abiding citizens. Regardless of the numerous benefits of opiate replacement therapy, it is still strictly monitored and regulated by the state.
Suboxone is comprised of buprenorphine (an opioid partial agonist) and Naloxone (an opioid antagonist. Opioid agonists work to release opioid neurotransmitters within the nervous system, whereas opioid antagonists work to prevent the opioid agonist from binding to opioid receptors. Thus, Naloxone is used to deter addicts from injecting suboxone straight into their veins.
For many opioid dependent persons, Naloxone achieves its intended effect by making it almost impossible to attain a high. However, it is still possible for non-dependent persons to achieve a high with Suboxone. The binding affinity for buprenorphine still proves stronger than that for Naloxone; therefore, there is much support leading to the conclusion that Naloxone does little to prevent Suboxone abuse.
Common side effects that are associated with Suboxone include:
The most severe adverse effect associated with opioids is respiratory depression, which is the main cause for death during overdose. Thankfully, buprenorphine behaves differently in that respect, because it has a ceiling effect for respiratory depression. Thus, there is a certain point at which a patient’s respiratory depression will no longer increase, although mixing buprenorphine with depressants such as alcohol or benzodiazepines could lead to death by respiratory depression.
There is also the possibility of a phenomenon referred to as precipitated withdrawal. This occurs when Suboxone is taken shortly after administering other short-acting opioids like hydrocodone (Vicodin), morphine, heroin, oxycodone (Percocet), codeine and hydromorphone (Opana). Precipitated withdrawal can have intense adverse effects and may be one of the worst forms of withdrawal an addict can experience. Hence, it is of paramount importance to seek a healthcare professional, rather than choosing to self-treat opioid dependence with Suboxone.
Although methadone clinics are still the standard for detoxification in inpatient rehabilitation facilities, Suboxone has begun to garner increasing use and support among these facilities. Within an inpatient rehabilitation facility it is common for patients to be subject to an initial detox phase followed by the treatment phase.
Suboxone is regularly administered during the detox phase to reduce the symptoms of withdrawal. It is sometimes accompanied with benzodiazepines: a mild anxiolytic used in the treatment of anxiety, insomnia and restless legs syndrome. It may also be accompanied by blood-pressure reducers and anti-inflammatory medication.
The use of Suboxone is only permitted during the detox phase of rehabilitation, which can last between five and ten days. Sometimes patients may require additional time in detox, if they are being detoxed from multiple addictive substances at once. During the detoxification process, patients will be given one to two doses each day while being monitored by a healthcare professional. One dose can normally provide relief from withdrawal symptoms anywhere from 48 to 72 hours, but some patients may require higher dosages to ensure a consistently active level of the drug within their nervous system.
Once the patient receives medical clearance in the detox phase, they are then able to begin the treatment phase. Usually, the treatment phase will be comprised of multiple forms of group and individual therapy sessions with psychologists, chemical dependency counselors, psychiatrists, social workers and other healthcare professionals.
Patients who decide to voluntarily admit themselves into a rehabilitative program have the option of choosing which program they would like to attend. Patients also have the option to only take part in the detox phase of rehabilitation, but most facilities offer both phases. It is highly advised to attend both phases of the treatment, because the probability of success is greatly increased by doing so. The combination of utilizing Suboxone for detox and selecting continued treatment has proven to be highly effective.
On average, patients will usually spend around 30 days in rehabilitative care, but it is possible to extend it anywhere from 90 days to 6 months. One of the main objectives in drug rehab is forming networks of recovering addicts that serve to support and guide patients through the process. By successfully forming a support group, the relapse rate for recovering addicts is greatly reduced.
In summation, the use of Suboxone to treat opioid dependence has done wonders for those dealing with the affliction, but it is not enough alone to completely steer away from opioids altogether. In order to increase the chances of staying clean, patients must accompany Suboxone therapy with the inpatient rehabilitative treatments.
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