Suboxone is a prescription medication used in the treatment of opioid addiction. It is a combination of buprenorphine, a partial opioid agonist, and naloxone, a drug that stops opiates from binding to opioid receptors in the brain.
Buprenorphine was approved for use in the US in 2002, in an effort to help people struggling with addiction to heroin and opioid painkillers get medication-assisted treatment to detox. However, because buprenorphine can be tampered with in order to get high, pharmaceutical companies developed Suboxone. The developers believed that, by adding naloxone, people who took Suboxone could not get high off the buprenorphine in the medication; instead, the naloxone would bind to the opioid receptors first, prevent any uptake of buprenorphine, and send the person into withdrawal. The ratio of buprenorphine to naloxone in Suboxone is about 4:1.
Recent reports, however, suggest that even Suboxone is becoming a drug of abuse. Although buprenorphine does not induce the immediate, euphoric high of heroin or oxycodone, people who struggle with addiction are still finding ways to abuse Suboxone and buprenorphine to achieve a high.
How Do People Become Addicted to Suboxone?
One of the biggest issues brought up in reports about Suboxone abuse is the lack of oversight involved in prescribing practices. The Substance Abuse and Mental Health Services Administration (SAMHSA) offers information about buprenorphine and Suboxone prescriptions, and how people struggling with opioid addiction can use these as part of a larger treatment plan. The key, however, is the treatment plan. SAMHSA states clearly that counseling is helpful alongside a plan that tapers the Suboxone prescription, so the individual eventually does not need to take this medication anymore. Suboxone should be used to help people struggling with opioid addictions to end their physical dependence on opioids, but it is not the solution for overcoming an addiction.
The National Alliance of Advocates for Buprenorphine Treatment (NAABT) states the same thing: Suboxone is designed to suppress the physical sensations of opioid withdrawal. This is sometimes called “maintenance therapy,” but the goal of this type of medication therapy is not to keep the person on the medication forever. Instead, over months or years, individuals work to end their physical dependence, understand their addiction, and rebuild their lives without drugs.
Buprenorphine acts on the same brain system as short-acting opioids like morphine, hydrocodone, heroin, and fentanyl. Although it does not create the same type of intoxication, it can still be taken in large doses to induce a high. Without proper oversight for tapering, people who struggle with addiction may divert their Suboxone prescriptions to get money for other drugs; or they may find ways to tamper with the medication to bypass the time-release aspects of the drug and get high.
One of the more common methods of abuse is to dissolve Suboxone filmstrips in water and then inject the drug intravenously. The pill form of the drug can also be crushed and snorted. Despite the developers’ intention that the presence of naloxone would discourage abuse, many users find they can still get high off Suboxone when they abuse it.
As more doctors are able to prescribe Suboxone, more of the medication is being diverted, or sold illegally, according to SAMHSA. The article noted that 17 percent of doctors surveyed on Suboxone prescribing practices believed that the primary source of illegal Suboxone on the streets was due to lax prescription regulation and poor oversight from their fellow medical professionals. Interviews with people struggling with Suboxone and opioid addiction corroborated this statement.
Who Is Likely to Abuse Suboxone?
People who struggle with opioid addiction, or who abuse drugs recreationally, are at risk of abusing Suboxone. The Center for Substance Abuse Research (CESAR) gathered evidence from individuals who took Suboxone, either as a prescription or recreationally, and found that those who abused Suboxone said it worked best if the individual had detoxed from other opioids. Without any other drugs in the body, buprenorphine could intoxicate the user.
The SAMHSA article found in one survey in Massachusetts that 90 percent of Suboxone use through diversion involved people attempting to end their opioid addiction on their own. However, one-third of Massachusetts Suboxone abusers reported that they did abuse the medication specifically to get high. Doctors who are able to prescribe Suboxone are limited to between 30 and 100 patients at a time. Although this might seem like a low number for a general practitioner, it might be too high a number when patients need adequate oversight during tapering.
SAMSHA also noted that an increasing number of physicians were prescribing Suboxone to treat pain. The report noted that there are few statistics analyzing how many of these patients struggled with opioid addiction, but did suggest that these patients were a greater diversion risk.
Buprenorphine is a Schedule III drug, because the Drug Enforcement Administration believes the medication has a clear, helpful use, but it can still be a drug of abuse.
Symptoms and Side Effects of Suboxone Addiction
Because Suboxone has buprenorphine, a partial opioid agonist, the symptoms of intoxication are similar to those of other opioid medications. Symptoms include:
- Confusion or delirium
- Small pupils
- Sleepiness, drowsiness, or lack of alertness
- Nausea or vomiting
- Slowed or shallow breathing
- Stomach pain
- Difficulty falling asleep or staying asleep
It is important not to consume other opioids or alcohol while taking Suboxone, as this can increase the risk of overdose and the potential for breathing to stop.
Suboxone Abuse Dangers
It is possible to overdose on Suboxone and buprenorphine. According to an investigative piece from The New York Times, Suboxone and Subutex (which does not contain naloxone) were considered “primary suspects” in 690 overdose deaths worldwide, 420 of which were in the US. These deaths were reported to the Food and Drug Administration starting in 2003 through September 2013.
Another news article from North Carolina discussed smuggling Suboxone into prisons, particularly in filmstrip form. The article noted that Suboxone was the preferred “fix” for those who could not find or afford heroin. The filmstrips were easy to smuggle inside books or behind postage stamps. If a person is exposed to an addictive substance in prison, they are less likely to receive appropriate treatment while incarcerated.
Suboxone withdrawal symptoms include:
- Sneezing or runny nose
- Watery eyes
- Tingling or numbness on the skin
- Nausea or vomiting
- Rapid heartbeat
- Rigid muscles
These withdrawal symptoms are similar to those of other opioid drugs. Although Suboxone is used to ease withdrawal symptoms, when not tapered with proper oversight, the medication can lead to dependence and withdrawal, if stopped suddenly.
Because buprenorphine is a long-acting drug, it remains in the body for a long period of time. Only half of the drug is excreted from the body after two days, since the drug has a 37-hour half-life. The medication should be fully cleared from the body in nine days if the person stops taking the medication “cold turkey.” This means that people who abuse Suboxone can experience withdrawal symptoms for longer than with short-acting opioids like Percocet or morphine.
Stopping Suboxone suddenly is never recommended. There is a higher chance of relapse and subsequent overdose when a person attempts to detox from any opiate on their own. Instead, professional help from a doctor or rehabilitation program is needed.
When a person becomes addicted to Suboxone, there are no other medications to ease withdrawal symptoms. However, a doctor can taper the dose to help the person transition off this medication. With this tapered approach, the person is less likely to experience intense withdrawal symptoms and less likely to relapse. It’s incredibly important for the person to find a medical professional who will work closely with them on tapering. With reports of doctors prescribing Suboxone and then failing to oversee their patients, the burden is placed on the individual to find the right help.
A comprehensive rehabilitation program can make this process easier. Both inpatient and outpatient programs should staff medical professionals who will work with clients closely to make sure the tapering process eases them off physical dependence. A solid rehabilitation program will also help the individual with other aspects of addiction recovery. Withdrawal is just one step in the overall process of overcoming addiction. Individual counseling and group therapy, along with social support and an aftercare plan, are all necessary components of the process.