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Subutex is an opioid-derived medication that is routinely used in the treatment of addiction to other opiates, such as heroin and prescription opioid pain relievers.
Released in 1982, this form of buprenorphine was launched as Subutex, a sublingual form of the drug that dissolves under the tongue. It was initially promoted as a pain reliever.
Later, Subutex would evolve into the treatment drug it is known to be. Subutex was especially recommended for its lower likelihood of abuse. Subutex in its sublingual form was discontinued in 2012 in the US, though it is still available in generic form.
Today, Subutex is used solely for its treatment purposes in helping people wean off other opiates. The active ingredient in Subutex – buprenorphine – has been noted as having an 88 percent success rate among people who use it for this reason, per The Fix.
It is rarely used for the treatment of pain anymore except in individuals who may be more likely to abuse or grow dependent on other typical painkillers.
Buprenorphine was prescribed 9.3 million times in 2012, according to the Drug Enforcement Administration.
People who abuse Subutex are usually already addicted to other opioids. Those who are dependent on painkillers may look to Subutex as a mechanism of furthering their addiction after doctors cut them off from additional pain reliever prescriptions.
In 2013, opioid painkillers were prescribed 207 million times, per the National Institute on Drug Abuse. People who abuse opioid painkillers may also sell Subutex or buprenorphine to others who use the drug, in an effort to finance their own substance use habits.
Many people are under the false presumption that Subutex is less likely to produce addiction or be abused. This isn’t true. In fact, because Subutex can be abused, its counterpart, Suboxone, was created. Suboxone is a combination of the buprenorphine – a key part of Subutex – and the additional ingredient naloxone. The naloxone helps to create a ceiling effect that makes it harder to get high off Suboxone, even when large doses are taken. Subutex is buprenorphine alone and no such limitation exists on it.
Many people who abuse Subutex have already participated in some form of opioid addiction treatment. One of the drawbacks of Subutex and other buprenorphine-based treatment drugs is that they don’t require daily attendance at a clinic the way methadone does. Those who are prescribed methadone must visit a clinic or doctor’s office on a daily, or near daily, basis in order to receive the drug.
With buprenorphine, doctors can attain certification to prescribe the drug and dole it out as they would any prescription. Any licensed physician can prescribe buprenorphine, but they must complete training to be certified to do so first. They generally give out 30-day supplies of buprenorphine at one time. Since drugs like Subutex have become more available, the rate of side effects and overdoses stemming from buprenorphine has increased. The Substance Abuse and Mental Health Services Administration notes there were 30,135 emergency room treatment cases due to buprenorphine in 2010.
Treatment for Subutex addiction is similar to treatment for any opioid addiction. Since medication maintenance treatment is often part of opioid addiction treatment, it is sometimes involved in Subutex treatment; however, it is complicated by the fact that Subutex in and of itself is a treatment drug.
With opioid addiction treatment, clients are often placed on another opioid-based drug, which they are slowly weaned off over time, helping to avoid uncomfortable withdrawal symptoms. This type of approach may still be possible even when the individual is abusing a medication that would normally be used in these situations. In the case of an addiction to Subutex, methadone may be the answer.
Methadone is similar to buprenorphine, but its use in opioid addiction treatment involves more heavy supervision. Again, individuals who participate in these programs need to show up in person for their daily dose, and often, they’ll need to provide a urine sample for drug testing at that time too. Methadone treatment has been reported to have efficacy rates as high as 90 percent, per the California Society of Addiction Medicine.
Since those who suffer from Subutex addiction have often been shown to be susceptible to abusing treatment drugs, inpatient treatment is recommended if methadone is being used. This significantly decreases the likelihood that the person will abuse the treatment drug due to the 24-hour supervision given and the reduced opportunities to do so.
In other instances, maintenance medications may not be used at all for those in recovery from Subutex addiction. While the initial withdrawal process will involve uncomfortable symptoms, medications can be given on an as-needed basis to address those symptoms. In addition, continual psychological support and therapy will be available.
On the flipside, when someone is using Subutex as a treatment drug, it can be tempting to stay on it on a long-term basis. This isn’t ideal, and the ultimate goal is to taper off the treatment drug.
Weaning off Subutex happens at a different rate for everyone, and the tapering schedule is determined by supervising physicians. A starting dose may be set as low as 4 mg, but most individuals will need 8 mg on the starting day. The need for 8 mg over 4 mg is based on the development of withdrawal symptoms, which is actually the goal. The National Alliance of Advocates for Buprenorphine Treatment reports the dose should be increased by 2 mg to 4 mg each day until a target dose of 16 mg or greater is achieved by day three and withdrawal symptoms are stable. Over time – which may be months or even years – the dose is slowly decreased as the client progresses. If at any time a client is experiencing a high, the dose should be dropped in 2 mg increments.