Suboxone is a combination medication used to ease opioid withdrawal symptoms. These symptoms are painful and highly distressing. Symptoms include:
- Vomiting and anorexia
- Drug cravings
- Restless leg syndrome and insomnia
- Muscle and joint pain
- Extreme anxiety and weakness
- Feeling hot and then cold
The acute phase can last for up to ten days to two weeks. Other symptoms, such as insomnia and weakness, can persist for as long as several months. Opioid withdrawal is very difficult to endure. It’s no wonder people who are addicted to opioids continue to use their drug of choice just to avoid it. Others, who would like to quit, aren’t willing to do so without some sort of medical assistance.
What Is Suboxone
Suboxone contains two medications. One is buprenorphine, which is a synthetic opioid. It helps to curb withdrawal symptoms and drug cravings by partially activating the same opioid receptors in the brain that heroin and other opioids do. It’s not a full opioid agonist, however. This means that its ability to activate opioid receptors is only partial. It has a ceiling effect. A ceiling effect means that buprenorphine will not work to ease withdrawal symptoms beyond a certain dose. Suboxone daily doses are generally around 16 milligrams. Some people feel fine on less. Doses beyond 32 milligrams are not recommended.
Suboxone also contains naloxone, a drug used to treat opioid overdose. It’s widely known by its brand name, Narcan. It’s included at doses equal to one-quarter of the buprenorphine content. If you’re taking a 4 milligram dose of buprenorphine, then you’re getting 1 milligram of naloxone. The naloxone is included to discourage abuse of the buprenorphine if it’s injected. When taken orally as directed, the amount of naloxone won’t have much effect, if any. However, if it’s injected, it will block any euphoric effects from the buprenorphine. People tolerant to opioids, as heroin addicts are, rarely experience any euphoria from oral doses of Suboxone.
Suboxone is generally safe for most people. It’s certainly safer than using heroin, particularly if it’s injected. Intravenous injection of heroin can lead to endocarditis, an infection of the heart valves than can easily kill. If the damage to the heart valves is severe enough, the person will die without open-heart surgery to replace them. This type of surgery, even if successful, often leaves the patient with permanent, disabling health problems, such as weakness and shortness of breath.
People using heroin, even if it’s not injected, are still at a high risk of overdose. This is because the heroin scene has changed in recent years. Much of the heroin sold is now cut with fentanyl, a synthetic opioid about 50 times stronger than heroin. Fentanyl has analogues, or chemical cousins, even stronger than that. These are sometimes used as cutting agents, too. It’s not hard to see how an unwitting heroin user could easily overdose and die from heroin cut with fentanyl.
The Suboxone Controversy
The use of Suboxone for the treatment of heroin addiction is controversial. It’s a synthetic drug. It’s not derived from opium like heroin is. Suboxone has only been in use as a treatment for opioid addiction since about 2002. Heroin has been around since at least the 1890’s. Much more is known about heroin than Suboxone. Suboxone has some peculiar side effects not generally seen with natural and semi-synthetic opioids:
- Numbness in mouth
- Red tongue
- Redness inside of mouth
There is no way to be sure what these peculiar side effects might mean for long-term Suboxone users.
Suboxone has other problems, too. It’s addictive. It generally produces a protracted, highly unpleasant withdrawal syndrome that lasts at least a month. This is because the drug has an extremely long half-life. A half-life is an expression of the time it takes for the body to metabolize, or break down, half of the dose of an ingested drug. Buprenorphine’s half-life is a whopping 24-42 hours. Because they stay in the body so much longer, long-acting drugs produce longer withdrawal timelines than short-acting ones.
Suboxone will cause a phenomenon known as precipitated withdrawal, or PW, if given too soon into the withdrawal process. It typically cannot safely be given any sooner than around 48 hours after the last dose of heroin without risking PW. Therefore, the heroin addict must be in full-blown withdrawal before they can obtain any relief. This is a definite drawback. Many heroin addicts simply aren’t going to suffer that long before getting relief. They are more likely to turn to methadone, which can be given at any time. At sufficient doses, methadone will stop withdrawal symptoms in their tracks within an hour or two at most. Methadone is also a synthetic opioid, but it’s full agonist, not a partial one.
The fact is, in contrast to methadone, Suboxone won’t work for everyone. People with very high opioid tolerance levels tend to be the ones not helped by buprenorphine. These people will need to use methadone to get relief. Both Suboxone and methadone can be used on either a temporary or permanent basis. Both can be used in decreasing doses over time to slowly detox from the heroin and then stop all drug use. Both can also be used as maintenance drugs. This means that a stable dose is taken daily to curb drug cravings and to keep withdrawal symptoms at bay. This allows a motivated individual to work and attend to family responsibilities.
A Miracle Drug?
Suboxone has been hailed as a miracle drug by its proponents. That’s probably not completely true, but it has allowed countless people to stop heroin use and pursue normal lives. Anything, whether it’s Suboxone or methadone, or drug treatment or whatever, is better and safer than continuing to use heroin.
If you’re trying to get off of heroin or any other drug, we can help. We have trained counselors available 24 hours a day to speak to you and assist you in finding the help you need. Just call us anytime at 877-978-3125. We look forward to helping you change your life.