What Suboxone Treats

Prescription drug abuse is becoming an increasingly common means by which people manage life. As a tolerance begins to build, users will begin adding to the recommended dosage to obtain the same effects as initially received, thereby resulting in an addiction. Nobody seeks out or predicts to become addictive to medication, but consequently their bodies and even minds crave the drug as continued use is abused.

Opioids, for instance, are commonly prescribed because of their effective analgesic, or pain-relieving, properties. Medications that fall within this class-referred to as prescription narcotics-include morphine (e.g., Kadian, Avinza), codeine, oxycodone (e.g., OxyContin, Percodan, Percocet), and related drugs. Morphine, for example, is often used before and after surgical procedures to alleviate severe pain. Codeine, on the other hand, is often prescribed for mild pain. In addition to their pain-relieving properties, some of these drugs, codeine and diphenoxylate (Lomotil) for example, can be used to relieve coughs and diarrhea.

Unfortunately, these particular types of drugs have a high rate of addictive qualities that, if not closely monitored, can result in abuse.

What Does Suboxone Treat?

Suboxone has been deemed as the opiate cure. It’s being used instead of methadone because of its safer and more convenient means of therapy for an opiate abuser. It’s a form of maintenance therapy for opiate dependence.

The active ingredient in Suboxone is buprenorphine. Buprenorphine is an opioid, which means it is a synthetic or man-made opiate. It is approved by the FDA for use as replacement therapy. It can also be used to detoxify or remove opiate dependence. This is done by substituting the medication for the opiate that is being abused, weaning the medication over a period of time and then discontinuing the medication with a reduction in the severity of withdrawal symptoms. These withdrawal symptoms can then be treated for 7-10 days and naltrexone can be administered orally by injection or pellet after a naloxone (Narcan) challenge.

How is the Suboxone Treatment Administered?

The Suboxone treatment walk-through presents a basic overview of office-based treatment for opioid dependence. Inevitably, the protocols will be adapted to fit the individual needs and strengths of each physician’s practice. The clinical pathway for office-based treatment of opioid dependence with Suboxone can be broken down into six phases:

1. Pretreatment Screening
   The goal of pretreatment screening is to determine whether office-based treatment is the best course of action for a particular patient. Pretreatment screening usually consists of a brief interview conducted either over the phone or in person. Patients who are accepted for treatment (ie, whose needs are suited to an office-based treatment regimen) are scheduled for their intake. (Physicians may prefer to perform intake and induction during the same visit.)

   Through a series of forms, pretreatment paperwork is helpful for treatment to proceed for everyone: Completed forms facilitate prompt care, while the patient handouts are a convenient reference tool and help to manage treatment expectations and adherence.

2. Intake
   The primary objective of the intake is to establish a medical record of a patient’s suitability for office-based treatment of opioid dependence. To this end, the intake should document the following:
   • Opioid dependence (through a comprehensive substance dependence assessment)

   • Absence of any significant untreated psychiatric conditions that might interfere with treatment (through a basic mental status evaluation)
   • Presence of psychiatric co-morbidity should not exclude patients from Suboxone treatment. Untreated or inadequately treated psychiatric disorders can interfere with the effective treatment of substance abuse. Alternatively, substance abuse can mimic, exacerbate, or precipitate psychiatric symptoms and disorders. Assessment is fundamental to determining whether symptoms reflect primary psychiatric disorder or substance-induced condition.

   The intake is also a good time to discuss the pros and cons of Suboxone treatment, patients’ treatment expectations, and any other issues or questions related to treatment.

3. Induction
   The goal of induction is to safely suppress opioid withdrawal as rapidly as possible with adequate doses of Suboxone. When a patient’s first induction visit is scheduled, it is important to remember that mild-to-moderate opioid withdrawal symptoms will occur. (otherwise, treatment may have to be postponed). The induction phase usually averages two to five days. To avoid any possible delay of treatment, physicians frequently begin induction immediately following the intake, rather than scheduling the induction for a separate visit.
4. Induction dosing
   Suboxone should be dosed to levels that produce the desired clinical effect: suppressing the withdrawal symptoms and cravings that trigger opioid use. Under-dosing during induction does not offer any clinical benefits. In fact, under-dosing may actually increase the risk of treatment failure because it fails to adequately control patients’ withdrawal symptoms and cravings. Patients whose symptoms and cravings are not suppressed may try to self-medicate with opioids or other substances. Patients who test positive for supplemental drug use may need their Suboxone dose titrated upward.

   When considering the safety of higher doses during induction, physicians should be aware that Suboxone can reduce respiratory rate. However, because buprenorphine is a partial opioid agonist, when taken alone it exhibits a “ceiling effect” on respiratory depression—unlike full opioid agonists with which respiratory depression continues increasing as the dose increases. This “ceiling effect” means Suboxone by itself is unlikely to cause death in the event of an overdose.

5. Upon leaving the office
   Some physicians prefer to prescribe enough Suboxone so that patients can take additional doses at home as needed. In such instances, physicians may ask patients to document their withdrawal symptoms and Suboxone.
6. Stabilization
   Induction is completed when the patient:
   • Experiences no withdrawal symptoms
   • Experiences minimal to no side effects
   • Has no uncontrollable cravings for opioids
   • Is not using additional opioids

   During the next phase, stabilization, the patient’s Suboxone dose is “fine-tuned.” The objective is to find the minimum dose necessary to hold the patient in treatment, suppress opioid withdrawal effects, and suppress other opioid use (this dose can be anywhere from 4 to 24 mg per day, depending on the individual).

   Psychosocial counseling usually begins during stabilization. The length of the stabilization phase will vary depending on the needs of the patient. Some patients elect to proceed directly from stabilization to medically supervised withdrawal. However, unless there is a compelling reason to avoid all opioid use, longer-term buprenorphine treatment (ie, maintenance) is usually recommended because of the higher likelihood for treatment success.

7. Maintenance
   The goals of the maintenance phase are:
   • Preventing opioid withdrawal symptoms
   • Suppressing opioid cravings
   • To greatly attenuate the use of self-administered opioids
   • To have Suboxone therapy and psychosocial counseling continue. Treatment compliance and progress are regularly monitored and may entail urine screening tests and other laboratory evaluations as appropriate.

   As the patient moves further along in treatment and their condition improves, the need for frequent monitoring generally abates. The duration of the maintenance phase depends on the individual needs of the patient and can range from weeks to years.

Suboxone Addition Help

If you or someone you know is struggling with a suboxone/opiate addiction and needs to quit Suboxone abuse, we can help. Please call our toll free number at (888) 371-5712. We are available 24 hours a day to answer your questions on suboxone/opiate addiction and treatment.
More About Suboxone Abuse

• Teen Suboxone Use
• Suboxone History
• Effects of Suboxone
• Suboxone and Buprenorphine
• Watch this Suboxone addiction video