The Case for Suboxone: When Harm Reduction Is Necessary

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dependant

Suboxone is the brand name for buprenorphine and naloxone — a drug combination that serves to manage opioid detox and addiction while limiting the potential for abuse of the drug. The buprenorphine binds to opioid receptors in the brain as an imperfect match that satisfies them just enough to think they are bound to illicit opioids like heroin and prescription pain relievers, without creating the euphoric high that those opioids do.[1] The naloxone component creates a ceiling effect that inhibits the user from being able to achieve any sort of high from taking increased doses of the drug. This additive mostly combats those substance abusers who attempt to dissolve Suboxone into a liquid solution and inject it. If injected, the naloxone actually induces symptoms of withdrawal.[2]

In the United States, 2.1 million are estimated to be dependent on opioid painkillers and 467,000 on heroin.[3] Introduced in America in 2002,[4] Suboxone is a semi-synthetic analogue of thebaine that has helped a great many achieve sobriety from their opioid addiction.[5] In 2012, an astounding 9.3 million prescriptions were written for buprenorphine in the United States.[6] Patients are placed on a regular dosage and tapered off it over time until they are no longer dependent on opioids. Whether you’re placed on the 16/4 mg, 2/0.5 mg, 4/1 mg, or 24/6 mg dosage, all of them come in tablets and strips that dissolve when placed under the tongue.[7]

Successful Suboxone

An initial study of Suboxone touted positive results for 88 percent of the participants after six months.[8] As with all first-time analyses of this nature, more research would be needed to form a concrete opinion of the drug’s effectiveness in treating opioid addiction. In 2011, another study came along that sought to clarify the long-term efficacy of the drug after treatment ends, and they discovered that fewer participants saw success.[9] Overall success rates were lower than initial claims, at 49 percent by the time participants reached at least 12 weeks of treatment.[10] Furthermore, when the drug regimen was discontinued, the success rate dropped considerably to only 8.6 percent.[11]
Suboxone is making a dent in the number of American citizens who are addicted to opioids. That being said, the number of people growing dependent on opioid drugs is steadily climbing, too. Admission rates for patients who abused prescription opioid painkillers increased nearly fourfold from 23,000 in 1999 to 90,000 in 2007.[12] Interestingly, while admissions for heroin only increased by 10 percent between 1999 and 2009, those who opted for medicated opioid therapy programs like Suboxone decreased by 10 percent in the same time period.[13]

Opioid Abuse

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Going untreated carries major risks to a substance abuser’s well-being, and opioid abuse can end in fatality. Prescription painkiller overdose kills 46 people every single day in the United States.[14] Heroin and cocaine combined actually kill fewer people, despite the heavier negative connotation that is often linked to these hard substances. Overdoses due to prescription opioids only jumped 1 percent from 2012 to 16,235 in 2013.[15] However, deaths stemming from heroin overdoses in 2013 totaled 8,257 — a noticeable 39 percent hike from the prior year.[16]

While the rate of prescription opioid pain reliever abuse is rising slowly, the rate at which these drugs are prescribed, misused, and abused is exorbitant. In 2012, 259 million prescriptions were written for pain relievers in America.[17] While the US population may make up a mere 5 percent of the global population, we consume 75 percent of all prescription drugs on the planet.[18] Many of the individuals prescribed these drugs will end up addicted after a period of misuse that in many cases isn’t even intentional. Alarmingly, some 52 million Americans aged 12 and older admit to using prescription drug non-medically at some point in their lives.[19]

Common Curve Balls

Sometimes, treatment isn’t simple and straightforward. Some patients have reactions to Suboxone that can’t be planned for. Others have extenuating circumstances or health conditions that make for a trickier treatment plan. This most frequently occurs with mental health issues.

Individuals who struggle with mental health disorders are no stranger to addiction and substance abuse. In fact, a reported 37 percent of alcohol abusers and 53 percent of drug addicts have at least one serious mental illness.[20] Many of these individuals have no idea they are suffering from anything until they’re in treatment. Less severe cases of mental illness include disorders, such as depression, anxiety, and drug-induced psychosis. Some research points to 17-37 percent of first-time psychosis experiences being related to substance abuse.[21]

If you do have a presenting mental health problem, medical supervision is of high importance due to the potential for drug interactions. Suboxone is highly reactive with hundreds of medications and must be managed properly by a skilled physician.

Anxiety and depression are both very common in substance abusers. Around 20 percent of all people who have an anxiety or mood disorder like depression have a substance abuse disorder, too.[22] Thus, a patient who regularly takes Xanax may be at risk for trouble breathing, coma, and even death while taking Suboxone.[23] Sidestepping benzodiazepines used to treat anxiety, patients who are on antidepressants while on Suboxone treatment may experience dizziness, fatigue, and trouble concentrating, as well as physical impairment while performing everyday tasks.[24]

Quite often, it is the symptoms of withdrawal that lead hopeful detoxing addicts back onto the path of substance abuse. Therefore, those who struggle to get clean and sober may fare best on an extended treatment plan with Suboxone. With the drug acting as a substitute for their favored substance, they can have a real shot at getting on progressing in a healthy and functioning manner while avoiding the uncomfortable side effects of withdrawing from opioids.

Some other medical conditions have posed risks to treatment in the past, but no longer do. Pregnancy is a great example of this. Buprenorphine has not been studied intensively enough to claim it is safe or unsafe for use during pregnancy, but some studies have shown promising results in favor of the drug for addicted moms-to-be. While the dropout rate for buprenorphine maternity patients in one study was higher at 33 percent than the methadone drop-out rate at 18 percent, infants whose mothers were on buprenorphine had milder symptoms of neonatal abstinence syndrome, and needed only 11 percent as much morphine to control the syndrome symptoms as methadone moms did.[25] This is especially encouraging since the rate of opioid drug abuse among pregnant woman has been increasing in recent years. Among nearly 57 million births, rates of opioid abuse during pregnancy jumped 127 percent from 1.7 in every 1,000 women in 1998 to 3.9 per 1,000 in 2011.[26]

Suboxone’s Side Effects

No drug is without side effects, and Suboxone is no exception. Most patients will experience some range of side effects when taking Suboxone, but the majority agree that these effects are far less bothersome than those that come with withdrawing from an opioid drug. Over time, many of the side effects may dissipate on their own without the need for any medical intervention. The most frequent side effect experienced seems to be headaches, which around 36.4 percent of patients will incur.[27] Other common side effects include:

  • Raspy cough
  • Weight fluctuations
  • Excessive perspiration
  • Edema, especially in the extremities
  • Tingling in the limbs
  • Flushed skin
  • Experiencing sensations of heat
  • Fever
  • Chills
  • Faintness
  • Lower back pain
  • Pain in the side
  • Trouble with or pain when urinating[28]
headaches

In many cases, discomfort during the initial detox period can be treated with medications like clonidine. Many programs promote this drug as a great jumpstart to a treatment plan, as it can alleviate withdrawal symptoms, such as:

  • Runny nose
  • Irritated mood
  • Anxiousness
  • Muscular pain
  • Cramps
  • Sweating

A more pleasant withdrawal period means the patient can focus on their psychological health, repairing damaged relationships in their life and preparing for life in recovery. Medications like clonidine are safe to use in conjunction with Suboxone while under medical supervision and can greatly improve the overall treatment experience.

The Suboxone Treatment Method

There are approximately 1,270 certified opioid treatment programs in America that are treating some 325,000 patients, with only 25,000 of them opting for buprenorphine treatment.[29] Suboxone treatment programs start off with an intake interview that covers medical history, as well as a psychological profile and thorough review of drug abuse habits. It is important to be honest during your intake interview, because the dosage of Suboxone you’re placed on will be based on the dosage and specific types of substances you are accustomed to abusing.

relapse

Opioid treatment programs are the primary form of harm reduction available to opiate addicts. In addition, needle exchange programs provide sterile injection equipment to injection drug users like heroin addicts. Syringe stations, where users can inject drugs on site to decrease the risk of infectious disease and overdose, are other harm reduction strategies now available to opioid abusers.

The abstinence-only approach is certainly the directive society preaches, and it remains at the core of drug resistance education programs. Which avenue will best suit you may not be discovered until you’re in the thick of treatment. That being said, there are pros and cons to both points of view. Nonetheless, those same programs have often been touted as ineffective at deterring youths from a life of drug abuse. The modern-day addict is looking for a way to get through life, holding down a job, keeping their family intact, and being a productive member of society. So who’s to say it’s a bad thing if the only way they can manage to do that is via a long-term opioid treatment regimen?

Of all recovering addicts, 40-60 percent will relapse.[30] This is far less likely for the substance abuser who is currently enrolled in an opioid treatment program. The biggest question looming around Suboxone is in regard to how long a patient should be on it. While initial intentions for the drug were to provide opioid addicts with a long-term detox option, the maintenance program has no strict limits. Technically, patients do not have to stop taking it, and some don’t, opting for long-term maintenance care.

Citations

[1]How does Buprenorphine work in the brain?” (2008 December). National Alliance of Advocates for Buprenorphine Treatment. Accessed March 18, 2015.

[2]What are the treatments for heroin addictions?” (2014 November). National Institute on Drug Abuse. Accessed March 18, 2015.

[3] Volkow, N. D. (2014 May 14). “America’s Addiction to Opioids: Heroin and Prescription Drug Abuse.” National Institute on Drug Abuse. Accessed March 18, 2015.

[4] “”Department of Health and Human Services.” (2002 October). Food and Drug Administration. Accessed March 18, 2015.

[5] Heel, R.C., Brogden, R.N., Speight, T.M. & Avery, G.S. (2012 October 15). “Buprenorphine: A Review of its Pharmacological Properties and Therapeutic Efficacy.” Drugs. Accessed March 18, 2015.

[6]Buprenorphine.” (2013 July). Drug Enforcement Administration. Accessed March 18, 2015.

[7]Suboxone Dosage.” (n.d.). Drugs.com. Accessed March 18, 2015.

[8] Matesa, J. (2011 April 13). “The Great Suboxone Debate.” The Fix. Accessed March 18, 2015.

[9]Painkiller abuse treatment by sustained buprenorphine/naloxone.” (2011 November 8). National Institutes of Health. Accessed March 18, 2015.

[10] Ibid.

[11] Ibid.

[12] Birnbaum, H.G., White, A.G., Schiller, M., Waldman, T., Cleveland, J. & Roland, C. (2011). “Societal Costs of Prescription Opioid Abuse, Dependence, and Misuse in the United States.” Pain Medicine. Accessed March 18, 2015.

[13] Ibid.

[14]Opioid Painkiller Prescribing.” (2014 July). Centers for Disease Control and Prevention. Accessed March 18, 2015.

[15] Arlotta, C.J. (2015 January 16). “Deaths Involving Opioids, Heroin Continue to Rise, Reports Show.” Forbes. Accessed March 18, 2015.

[16] Ibid.

[17]Opioid Painkiller Prescribing.” (2014 July). Centers for Disease Control and Prevention. Accessed March 18, 2015.

[18]Popping Pills: Prescription Drug Abuse in America.” (2014 January). National Institute on Drug Abuse. Accessed March 18, 2015.

[19] Ibid.

[20] Saisan, J., Smith, M. & Segal, J. (2015 February). “Substance Abuse and Mental Health.” Helpguide. Accessed March 18, 2015.

[21] Schanzer, B.M., First, M.B., Dominguez, B., Hasin, D. & Caton, C. (2006 October). “Diagnosing Psychotic Disorders in the Emergency Department in the Context of Substance Use.” Psychiatric Services. Vol. 57, No. 10. Accessed March 18, 2015.

[22]Substance Abuse.” (n.d.). Anxiety and Depression Association of America. Accessed March 18, 2015.

[23]Drug interactions between Suboxone and Xanax.” (n.d.). Drugs.com. Accessed March 18, 2015.

[24]Drug interactions between Suboxone and Prozac.” (n.d.). Drugs.com. Accessed March 18, 2015.

[25] Whitten, L. (2012 July 6). “Buprenorphine During Pregnancy Reduces Neonate Distress.” National Institute on Drug Abuse. Accessed March 18, 2015.

[26]Reported opioid abuse in pregnant women more than doubles in 14 years.” (2014 November 18). American Society of Anesthesiologists. Accessed March 18, 2015.

[27]Suboxone Side Effects.” (n.d.). Drugs.com. Accessed March 18, 2015.

[28] Ibid.

[29]Increasing Access to Medication to Treat Opioid Addiction – Increasing Access for the Treatment of Opioid Addiction with Medications.” (n.d.). American Association for the Treatment of Opioid Dependence, Inc. Accessed March 18, 2015.

[30]Addiction Science: From Molecules to Managed Care.” (2008 July). National Institute on Drug Abuse. Accessed March 18, 2015.