The opioid addiction epidemic in the US continues to be an issue of major concern for people from all walks of life.
According to the 2018 National Survey on Drug Use and Health, an estimated 2.0 million people aged 12 or older had an opioid use disorder involving prescription drugs (OxyContin, hydrocodone) or heroin or both.
Between 2010 and 2015, the national rate of opioid-related inpatient stays increased 34.3% and the national rate of opioid-related emergency department visits increased 74.2%. The challenges of treating addiction to prescription painkillers or to illicit drugs like heroin sometimes seem insurmountable.
The FDA has approved 3 medications (buprenorphine, methadone and naltrexone) that have been shown to be effective at managing opioid withdrawal symptoms and reducing opioid cravings. Two of these medications—buprenorphine and methadone—are themselves opioids and are therefore carefully regulated and tightly controlled. Both carry with them a significant potential for overdose, abuse and diversion.
What Two Drugs are in Suboxone?
Suboxone is a combination of two drugs: buprenorphine and naloxone. Buprenorphine is referred to as an “opioid partial agonist,” which means that although it binds to the body’s opioid receptors, it produces a milder high than a full opioid agonist, such as heroin or a prescription painkiller. Buprenorphine’s bond to opioid receptors is also very strong and long-acting, which means that it inhibits the user from experiencing the effects of any full opioids by blocking access to opioid receptors.
Naloxone, on the other hand, is an opioid antagonist, meaning that it blocks the body’s opioid receptors. It’s only absorbed and activated by the body when Suboxone is injected, as opposed to being taken orally as prescribed. After being injected into the bloodstream naloxone counters the action of opioid drugs in the brain, essentially “shutting off” the high. This results in the user feeling immediate and unpleasant withdrawal symptoms, and acts as a deterrent for people to misuse and divert the medication.
Research described by the National Institutes of Health shows that people who are treated for addiction with Suboxone have a substantially higher chance of staying clean during treatment than those who try to quit “cold turkey.”
Suboxone has been shown to be similarly effective to methadone in suppressing opioid use, and is considered safer, as it has a lower abuse potential and a lower risk of overdose.
Suboxone Addiction and Abuse
Although the buprenorphine/naloxone combination Suboxone generally ranks as the least-abused opioid among those tracked in the U.S., there’s still a potential for misuse. Like other opioids, it causes physical dependency when taken regularly over a long period of time.
Numerous studies have revealed that many people who use Suboxone illicitly often do so in an effort to self-treat or self-manage opioid withdrawal symptoms. Non-medically supervised use of Suboxone is dangerous, particularly when injected. Injecting Suboxone comes with the risks of developing abscesses, infections, and acquiring bloodborne illnesses such as HIV and hepatitis.
Overdoses caused by Suboxone as well as buprenorphine alone are rare, and fatal intoxications are almost always attributable to mixed intoxication with other opioids, benzodiazepines, or alcohol.
Signs and Symptoms of Suboxone Abuse or Addiction
Suboxone abuse often begins after an individual is legitimately prescribed the drug to help them to detox from abuse of other opioids, such as prescription painkillers (e.g., OxyContin, hydrocodone) or heroin. If a prescribing doctor isn’t fully trained in substance abuse treatment, they may give longer-term prescriptions or lack the resources to properly monitor patient progress.
Recognizing addiction or abuse of Suboxone is often based on behaviors that indicate a legitimate prescription is being misused. These signs can include:
- Too many pills missing from a bottle based on dosing amounts.
- Secretiveness or lying about medications.
- “Doctor shopping” (i.e., obtaining multiple prescriptions from multiple doctors or pharmacies).
In other cases, Suboxone may not be prescribed at all, but may be obtained from supplies diverted illicitly either to help individuals self-manage withdrawal symptoms, maintain addictions to other drugs, or in attempts to get high.
Other ways of obtaining Suboxone illicitly include thefts from physicians and pharmacies and illegal importation.
As with any kind of addiction, there are other signs that may occur. These signs are used by doctors to diagnose substance use disorders according to The Diagnostic and Statistical Manual of Mental Disorders (DSM-5).
- Being unable to control substance use, consuming more than planned, or being unable to stop.
- Craving the substance, and spending large amounts of time focused on obtaining and using it.
- Having problems in relationships and with daily responsibilities.
- Continuing use despite health issues or other consequences.
- Giving up activities in favor of substance use.
- Using the substance in dangerous situations.
Suboxone abuse may point to the abuse of other opioids or of central nervous system depressants, such as benzodiazepines or alcohol. This is an important factor to be aware of if Suboxone abuse is suspected.
People who use Suboxone in combination with benzodiazepines and/or alcohol are at higher risk of severe complications than those who are abusing Suboxone alone. The reason for this is that all three substances act on the body in a similar way, including by slowing heartbeat and respiration. The combination can lead to a fatal overdose.
Long-term Effects of Suboxone Addiction
Because Suboxone is an opioid, it can cause some of the same issues as other opioids with long-term use. According to the National Institute on Drug Abuse, these include:
- Insomnia and restlessness.
- Decreased ability to concentrate.
- Damage to the heart and circulatory system.
- Damage to the respiratory system.
- Brain damage caused by lack of oxygen resulting from slowed breathing (hypoxia).
Long-term use and abuse of any opioid increases the body’s tolerance to the drug, causing the person to continually increase the amount taken as the body adjusts to lower doses. This, in turn, can increase chances for overdose after a period of abstaining from the drug. The person tries to return to the high dose used before stopping; however, the body has lost its tolerance, and overdose is likely
Treatment for Suboxone Addiction
When a person is abusing Suboxone, they may be addicted to other drugs as well. This can indicate that the person is not interested in treatment or recovery from addiction, but instead wants to continue using drugs. This can be a difficult position to be in, because one of the key indicators that treatment will be successful is the individual’s motivation to get and stay clean. People who aren’t seeking help should be encouraged to get treatment and successfully achieve recovery.
People who use any of these types of drugs may have other co-occurring psychological issues, including anxiety or depression, that the person is self-medicating through the substance abuse. It’s important to understand how these mental health disorders may co-occur with and have an effect on the substance use disorder. A program that treats co-occurring disorders offers the greatest opportunity for a positive outcome and long-term recovery.
Treating these addictions includes several steps, including detox, therapy, peer support groups, and aftercare. The main intention is to promote relapse prevention, helping the person build an arsenal of tools to avoid returning to drug use. As a chronic disorder, substance abuse has a high potential of relapse and no cure. However, with dedication and motivation, substance addiction and abuse can be managed successfully.