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Understanding How to Use Suboxone to Get Off of Heroin

Suboxone is a combination of naloxone and buprenorphine. This prescription medication is used to get people off of heroin.

What Is Suboxone?

In 2002, Suboxone received approval from the U.S. Food and Drug Administration to be used as a treatment for opioid addiction. It comes in two forms, including a film and a sublingual tablet.

Buprenorphine is a partial opioid antagonist. It blocks the brain’s opiate receptors to reduce withdrawal symptoms and cravings for heroin and other opiates.

While methadone used to be the medication of choice to treat heroin addiction, buprenorphine is now the preferred option. It can be prescribed to be taken at home, whereas methadone requires that individuals visit a methadone clinic to get their daily dose. 

The naloxone in Suboxone is an opiate antagonist. This means that it works to block opiate drug effects.
Naloxone acts as an abuse-deterrent since it will send a user into immediate opioid withdrawal. If someone attempts to crush Suboxone to snort or inject it, the naloxone component will be activated, rendering the drug useless to abuse.

This makes Suboxone much less likely to be abused than methadone or buprenorphine on its own.

Effectiveness of Suboxone

Studies have been done to determine how effective Suboxone is when treating opioid addiction. One study, published in JAMA Internal Medicine, concluded that relapse rates are lower among people who stay on the drug for a longer time compared to people who are more quickly tapered off it.

Some people view this medicine as replacing one opioid with another. This isn’t the case.

Instead, medication-assisted treatment (MAT) allows individuals to focus on therapy and getting to the root causes of their addiction without being distracted by withdrawal symptoms and cravings. When combined with counseling, support, and treatment, Suboxone can help people achieve recovery. 

Side Effects

This medication has the potential to slow breathing. This could be life-threatening in some situations.

If someone has issues with slow breathing, bluish lips, long pauses between breaths, or is hard to wake up, call 911. People should immediately get medical attention for the following side effects:

  • Confusion
  • Extreme weakness
  • Coordination loss
  • Liver issues (appetite loss, clay-colored stools, stomach pain, dark urine, or jaundice)
  • Opioid withdrawal symptoms (shivering, increased sweating, runny nose, diarrhea, goosebumps, feeling cold or hot, watery eyes, or muscle pain)
  • Slurred speech or blurry vision
  • Low cortisol levels (nausea, dizziness, weakness or tiredness that gets worse, loss of appetite, or vomiting)

The following are common side effects of this medication:

  • Cough
  • Feelings of heat or warmth
  • Redness or flushing of the skin
  • Hoarseness
  • Difficult or painful urination
  • Chills
  • Feeling dizzy, lightheaded, or faint
  • Fever
  • Headache
  • Side or lower back pain
  • Sweating

When someone takes more Suboxone than they are supposed to, there is a risk for overdose. If an overdose occurs, the symptoms may include the following:

  • Blurry vision
  • Troubled breathing
  • Drowsiness
  • Bluish or pale fingernails, lips, or skin
  • An overall calm or relaxed feeling
  • Unusual weakness or tiredness
  • Confusion
  • Faintness, dizziness, or lightheadedness
  • Pinpoint pupils
  • Sleepiness

While it is not common, it is possible to experience serotonin syndrome when someone is taking Suboxone. When this happens, serotonin (a type of brain chemical) starts to build up in the body. Unconsciousness and death are possible if someone has this condition, and they do not get treatment. With treatment, most people recover and have no long-term effects.
The following are symptoms of serotonin syndrome:

  • Restlessness or agitation
  • High blood pressure
  • Twitching of the muscles
  • Heavy sweating
  • Headache
  • Goosebumps
  • Rapid heart rate
  • Confusion
  • Muscle rigidity or lost muscle coordination
  • Diarrhea
  • Shivering
  • High fever
  • Irregular heartbeat
  • Seizures
  • Unconsciousness

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Contradictions

People who have certain medical conditions might not be able to safely take this medication. It is important that people tell their doctor if they have the following conditions now or in the past:

  • Benign prostatic hypertrophy (enlarged prostate)
  • Difficulty urinating
  • Head injury
  • Spinal curvature that causes difficulty breathing
  • Liver, thyroid, kidney, or lung disease
  • Addison’s disease or other adrenal gland problems
  • Breathing or lung issues
  • Hallucinations
  • Stomach problems or condition
  • Gallbladder disease

This medication is rated in pregnancy category C by the FDA. This means that it remains unknown if this medicine will cause harm to a fetus.
If someone takes this medication during pregnancy, there is the potential for behavior changes, withdrawal symptoms in the newborn, breathing issues, or life-threatening addiction. It will get into breastmilk, so breastfeeding should be avoided when a woman is taking this medicine.

Drug Interactions

When someone is using this medication, they should avoid other opioids. The naloxone component will block those effects anyway.
The following may also not be safe when someone is taking Suboxone:

  • Antidepressants
  • Sleeping pills
  • Sedatives
  • Tranquilizers
Assorted pills including suboxone for getting off heroin

The prescribing doctor will review the person’s medical history when they need to prescribe a new medication.

This will help to ensure that there is a low risk of any potential drug interactions.

It is also important to avoid alcohol when taking this medication.

Combining Suboxone with alcohol can result in overdose, loss of consciousness, death, or life-threatening breathing issues.

Is It the Right Choice?

Every medication comes with some risks. It is important to understand the risks and how this medication works to make a choice about whether it may help a specific person.
Suboxone can help some people’s recovery process immensely. Other times, it isn’t a good choice for the overall recovery plan. 
The medication is never enough to address addiction on its own. It must be used as part of a comprehensive treatment program.

Sources

Treating Opiate Addiction with Suboxone. Verywell Health. Retrieved February 2019 from https://www.verywellmind.com/suboxone-for-opiate-addiction-49543

(December 2014) Primary Care-Based Buprenorphine Taper vs Maintenance Therapy for Prescription Opioid Dependence: A Randomized Clinical Trial. JAMA Internal Medicine. Retrieved February 2019 from https://www.ncbi.nlm.nih.gov/pubmed/25330017

What is Suboxone (Buprenorphine and Naloxone)? Everyday Health. Retrieved February 2019 from https://www.everydayhealth.com/drugs/suboxone

(April 2016) Buprenorphine-Naloxone Use in Pregnancy for Treatment of Opioid Dependence. College of Family Physicians of Canada. Retrieved February 2019 from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4830675/

Suboxone Patient Information Including Side Effects. RxList. Retrieved February 2019 from https://www.rxlist.com/suboxone-drug/patient-images-side-effects.htm

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