Author

Quentin Blount

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Medical Reviewer

Dr Jillian Foglesong Stabile

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Suboxone: The Buprenorphine and Naloxone Combination

Suboxone is a prescription medication used to treat opioid addiction. When taken as directed as part of a medication-assisted treatment (MAT) program, it relieves opioid withdrawal symptoms and reduces cravings, which in turn helps reduce the likelihood of relapse. A 2017 study found that Suboxone lowers the risk of fatal overdoses by approximately 50%.¹

Medication-Assisted Treatment (MAT)

Medication-assisted treatment (MAT) is offered at many accredited alcohol and drug rehabs. It uses medications, counseling, and behavioral therapies as part of the treatment for opioid use disorders (OUD).

One MAT medication, known by its brand name Suboxone, is a safe and effective way to help people stop using prescription pain medications, heroin, and other opioids.

There are three main phases of a MAT program:

• Induction (the first 1-2 days)
• Stabilization (next several weeks)
• Maintenance (as long as you need).²

Suboxone is now the preferred treatment medication for opioid addiction. It is prescribed more often than any other MAT medication.

What is Suboxone?

Approved by the FDA in 2002, Suboxone is an oral prescription drug that is used to treat opioid addiction. As of 2023, a medical provider with a DEA license that provides Schedule III authority can prescribe Suboxone.⁸ The medication must be dispensed by a pharmacy. Suboxone should never be taken for conditions that fall outside of approved use unless directed by your prescribing medical professional.

Suboxone contains two individual drugs: buprenorphine and naloxone.

• Buprenorphine is a partial opioid agonist. It provides relief from cravings and withdrawal symptoms by blocking opioid receptors in the brain. In other words, it satisfies the body’s physical dependence without producing a high.³
• Naloxone is an opioid antagonist. It works by blocking the effects of opioid drugs, including pain relief or feelings of well-being that can lead to opioid abuse. Naloxone is used as a deterrent to prevent the diversion and misuse of suboxone.⁴

Suboxone comes in a sublingual film or tablet form, and it’s used as part of a comprehensive detoxification program and for maintenance therapy as needed.

The following buprenorphine products are FDA approved for the treatment of OUD:

• Generic Buprenorphine/naloxone sublingual tablets
• Buprenorphine sublingual tablets (Subutex)
• Buprenorphine/naloxone sublingual films (Suboxone)
• Buprenorphine/naloxone sublingual tablets (Zubsolv)
• Buprenorphine/naloxone buccal film (Bunavail)
• Buprenorphine implants (Probuphine)
• Buprenorphine extended-release injection (Sublocade)

Understanding Outpatient MAT With Suboxone

An outpatient MAT program allows you to get the medications and therapies you need while living at home or in a sober living house and still working, going to school, and attending to family responsibilities. Treatment sessions generally last for a few hours a day, 3-5 times a week. Alternatively, you may attend an Intensive Outpatient Program (IOP) up to five days per week for 8-9 hours each time.

While Suboxone can be a helpful tool in mitigating painful withdrawal symptoms, it is not a cure for addiction in and of itself. Addiction is attributed to a variety of factors, including genetics, environment, and personal experiences, including past trauma.⁵ Therefore, it’s essential that you have a long-term treatment plan that addresses the behavioral and psychological aspects of addiction. An outpatient MAT program can provide exactly that.

Forms of Therapy Used in Suboxone MAT Programs

In addition to medication, therapy is a key part of an outpatient drug rehab program. In fact, research shows that medication-assisted treatment combined with talk therapy is more effective at treating opioid addiction than using medication on its own.⁶ Talk therapy can help you work through past traumas and better understand why you initially began using drugs. It can also help you identify triggers and create new, healthy coping mechanisms.

Therapy usually takes place at an addiction treatment center, outpatient clinic, or in the private practice of a mental health practitioner and can take a variety of different forms. Common talk therapies include:

• Individual counseling: Taking place one-on-one with a counselor, individual therapy enables you to identify and address their personal issues.
• Group therapy: These support group sessions often follow a plan such as the 12-Step Program to Recovery used by Alcoholics Anonymous and Narcotics Anonymous. Group counseling provides support for others in the same situation.
• Couples and family therapy: A Marriage and Family Therapist (MFT) usually facilitates these therapy sessions. The aim is to counsel and support family members during the addiction treatment process.

Talk therapy incorporates a variety of methods and formats, and some of the most common are:

• Cognitive-behavioral therapy: CBT is frequently used to treat a range of mental health issues, including addiction. CBT includes several different but related techniques that link your thoughts and feelings to your actions, with the goal of breaking the cycle of negative thoughts causing detrimental addictive behaviors. According to one study, 60% of the patients who participated in CBT provided clean toxicology screens at their one-year check-ups.⁷

• Dialectical behavior therapy: A modified form of CBT, Dialectical Behavior Therapy (DBT) encourages you to develop skills that enable you to have improved emotional control and make healthier choices.

If you are still struggling to abstain from opioids, a more intensive treatment program might be required. Depending on the severity of your addiction, you might want to consider the following

• Medical detox: During medical detox, you are given medications to assist with withdrawal symptoms while under 24/7 care by medical professionals.
• Inpatient rehab: These residential addiction treatment programs are where you live on-site while receiving around-the-clock medical care and therapeutic support. Once detoxification is complete, you’ll begin a comprehensive addiction treatment program that involves a combination of individual counseling, group therapy, holistic therapies, and more.

What Are the Side Effects and Risks of Suboxone?

If you have been prescribed Suboxone as part of your medication-assisted treatment program, you may notice some side effects from the medication. Common side effects include:

• Anxiety
• Depression
• Fatigue
• Headache
• Insomnia
• Nausea
• Sweating

While uncommon, it’s important to note that some people do experience serious side effects from taking Suboxone, including breathing problems, liver damage, hormone issues, severe allergic reactions, or severe withdrawal symptoms. If you are experiencing these symptoms, you should seek medical attention immediately.

Additionally, you shouldn’t stop taking Suboxone without talking to your medical provider first. Working together, you can develop a taper schedule to slowly decrease the dosage amount over a specified period of time. If you stop treatment “cold turkey,” it can cause adverse effects and potentially lead to withdrawal symptoms.

Suboxone withdrawal symptoms are similar to other opiate withdrawal symptoms and include:

• Anxiety
• Chills
• Goosebumps
• Muscle aches and pains
• Nausea
• Restlessness
• Runny nose
• Stomach cramps or diarrhea
• Sweating
• Tremors or twitching
• Teary eyes
• Vomiting

Resources

• Sordo, L., Barrio, G., Bravo, M. J., Indave, B. I., Degenhardt, L., Wiessing, L., Ferri, M., & Pastor-Barriuso, R. (2017). Mortality risk during and after opioid substitution treatment: systematic review and meta-analysis of cohort studies. BMJ, 357, j1550.
• Medication Assisted Treatment Program Overview. (n.d.). MAT
• ‌Samhsa. (n.d.). Buprenorphine.
• ‌Samhsa. (n.d.). Naloxone.
• National Institute on Drug Abuse. (2018, June). Understanding Drug Use and Addiction Drug Facts. National Institute on Drug Abuse.
• Amato, L., Minozzi, S., Davoli, M., & Vecchi, S. (2011). Psychosocial and pharmacological treatments versus pharmacological treatments for opioid detoxification.
• ‌McHugh, R. K., Hearon, B. A., & Otto, M. W. (2020). Cognitive Behavioral Therapy for Substance Use Disorders.
• Removal of DATA waiver (x-waiver) requirement. (n.d.). SAMHSA. Retrieved May 26, 2023, from https://www.samhsa.gov/medications-substance-use-disorders/removal-data-waiver-requirement