What is "Suboxone"?
Currently, alcohol and opioid dependence are among the greatest threats to health in the United States. iTrust Wellness Group is proud to offer a pharmacological option for opioid dependence that has demonstrated efficacy and safety in long term studies (Fiellin, 2008).
In 2002, the FDA approved the use of the unique opioid buprenorphine (Subutex, Suboxone) for the treatment of opioid addiction in the U.S. Buprenorphine has numerous advantages over methadone and naltrexone. As a medication-assisted treatment, it suppresses withdrawal symptoms and cravings for opioids, does not cause euphoria in the opioid-dependent patient because it is a partial opioid agonist, and it blocks the effects of the other (problem) opioids for at least 24 hours. Success rates, as measured by retention in treatment and one-year sobriety, have been reported as high as 40 to 60 percent in some studies. Treatment does not require participation in a highly-regulated federal program such as a methadone clinic. Since buprenorphine does not cause euphoria in patients with opioid addiction, its abuse potential is substantially lower than methadone.
In short, Suboxone (Buprenorphine/Naloxone) is a prescription sublingual medicine used to:
• Treat opioid dependence. You need to be in a mild withdrawal before starting Suboxone.
• Prevent relapse to opioid dependence, after opioid withdrawal has started.
To be most effective, treatment with Suboxone (buprenorphine/naloxone)
should be paired with by therapy with a substance abuse/addiction certified counselor.
How does Suboxone work?
Most people cannot just walk away from opioid addiction. They need help to change their thinking, behavior, and environment. For this reason, “quitting opioids cold turkey” has a poor success rate – fewer than 25 percent of patients are able to remain abstinent for a full year. Opioids are highly addictive to our brain and stopping opioids "cold turkey" could cause serious and painful withdrawals. This is where medication-assisted treatment options like Suboxone and naltrexone benefit patients in staying sober while reducing the side effects of withdrawal and curbing cravings which can lead to relapse.
There are two medications combined in each dose of Suboxone. The most important ingredient is buprenorphine, which is classified as a ‘partial opioid agonist,’ and the second is naloxone which is an ‘opioid antagonist’ or an opioid blocker.
A ‘partial opioid agonist’ such as buprenorphine is an opioid that produces less of an effect than a full opioid when it attaches to an opioid receptor in the brain. Oxycodone, hydrocodone, morphine, heroin and methadone are examples of ‘full opioid agonists.’ For the sake of simplicity from this point on we will refer to buprenorphine (Suboxone) as a ‘partial opioid’ and all the problem opioids like oxycodone and heroin as ‘full opioids.’
When a ‘partial opioid’ like Suboxone is taken, the person may feel a very slight pleasurable sensation, but most people report that they just feel “normal” or “more energized” during medication-assisted treatment. If they are having pain they will notice some partial pain relief.
People who are opioid dependent do not get a euphoric effect or feel high when they take buprenorphine properly. Buprenorphine tricks the brain into thinking that a full opioid like oxycodone or heroin is in the lock, and this suppresses the withdrawal symptoms and cravings associated with that problem opioid.
Buprenorphine is a long-acting form of medicated-assisted treatment, meaning that it gets ‘stuck’ in the brain’s opiate receptors for about 24 hours. When buprenorphine is stuck in the receptor, the problem ‘full opioids’ can’t get in. This gives the person with opioid addiction a 24-hour reprieve each time a dose of Suboxone is taken. If a full opioid is taken within 24 hours of Suboxone, then the patient will quickly discover that the full opioid is not working – they will not get high and will not get pain relief (if pain was the reason it was taken). This 24-hour reprieve gives the patient time to reconsider the wisdom of relapsing with a problem opioid while undergoing medication-assisted treatment.
Another benefit of buprenorphine in treating opioid addiction is something called the ‘ceiling effect.’ This means that taking more Suboxone than prescribed does not result in a full opioid effect. Taking extra Suboxone will not get the patient high. This is a distinct advantage over methadone. Patients can get high on methadone because it is a full opioid. The ceiling effect also helps if buprenorphine is taken in an overdose – there is less suppression of breathing than that resulting from a full opioid.
How often do I need to take Suboxone?
Dosing schedules of Suboxone (buprenorphine/naloxone) depends on each individual. Your iTrust Wellness Group clinician will work with you and come up with a titration schedule to maintain a withdrawal-free state of being.
Some clients take Suboxone as little as one time a day, while others require more doses of the medication to maintain this sense of well being.
How much does Suboxone cost?
Treatment with Suboxone at iTrust Wellness Group is cash-only for confidentiality and safety reasons. Suboxone is a highly regulated and controlled medication and our providers want to ensure that clients seeking our care for Suboxone are serious about seeking treatment.
A consultation for Suboxone prescription last approximately 40 minutes and encompasses a psychiatric diagnostic evaluation, detailed family, psychiatric, and medical history. Our providers will spend extensive time educating the client during this appointment about what to expect during the induction process. The Suboxone consultation appointment rate is $200 and this is due at the time of service.
If clients are assessed as candidates for treatment with Suboxone, instructions will be provided to the client regarding a follow-up induction visit time. Inductions usually last 1-2 hours and are started in the office and when the client is in mild to moderate opioid withdrawal. A comprehensive urinalysis is a component of Suboxone inductions. Once the client is withdrawal-free in the office, he or she may return home with remaining medication. The goal of a Suboxone induction is to find a target dose where a client does not have signs or symptoms of opioid withdrawal and feels generally 'normal.' The provider will be available for consultation during the induction process in case any concerns or questions arise. The cost of the Suboxone induction appointment is $200 and this is due at the time of service.
Follow-up appointments for Suboxone are $200 and are generally monthly after the target dose of the medication is achieved.
Prescription medication coverage largely depends on your insurance carrier. Check with your insurance provider for specifics regarding prescription coverage of Suboxone sublingual doses. However, there are co-pay savings programs and discount cards available from the manufacturer. Information about billing and savings programs can be found below:
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Information about the co-pay savings program: Click HERE.
Is Suboxone safe?
All pharmacological treatment methods are not without the risks of adverse reactions or side effects. While Suboxone is generally well tolerated, common side effects include nausea, sleepiness, headache, dizziness, decreased appetite, and muscle cramps. A full explanation of common side effects, serious side effects, and other pertinent information related to Suboxone is available for reference HERE.
Additional Questions
We cannot cover all information related to Suboxone on our website and encourage our clients to schedule a consultation with one of our providers to see whether or not Suboxone is an appropriate and safe treatment option.
We also encourage clients to reference reputable online sources for additional information about Suboxone, including a medication guide published by the United States Food and Drug Administration (FDA) which is available HERE.
More information about how Suboxone works can also be found HERE.
References:
Fiellin, D. A., Moore, B. A., Sullivan, L. E., Becker, W. C., Pantalon, M. V., Chawarski, M. C., Barry, D. T., O'Connor, P. G. and Schottenfeld, R. S. (2008), Long-Term Treatment with Buprenorphine/Naloxone in Primary Care: Results at 2–5 Years. The American Journal on Addictions, 17: 116–120. doi:10.1080/10550490701860971
https://psychcentral.com/lib/how-is-suboxone-treatment-different-than-drug-abuse