Physicians who treat opioid addiction also have the option of utilizing ‘medication-assisted treatment,’ and the most common medications used in the treatment of opioid dependence today are methadone, naltrexone, and buprenorphine (Suboxone).
Most people cannot just walk away from opioid addiction. They need help to change their thinking, behavior, and environment. Unfortunately, “quitting cold turkey” has a poor success rate – fewer than 25 percent of patients are able to remain abstinent for a full year. This is where medication-assisted treatment options like methadone, naltrexone, and Suboxone benefit patients in staying sober while reducing the side effects of withdrawal and curbing cravings which can lead to relapse.
Methadone is an opioid and has been the standard form of medication-assisted treatment for opioid addiction and dependence for more than 30 years. Methadone for the treatment of opioid dependence is only available from federally-regulated clinics which are few in number and unappealing for most patients. In addition, studies show that participation in a methadone program improves both physical and mental health, and decreases mortality (deaths) from opioid addiction. Like Suboxone, when taken properly, medication-assisted treatment with methadone suppresses opioid withdrawal, blocks the effects of other problem opioids and reduces cravings.
Naltrexone is an opioid blocker that is also useful in the treatment of opioid addiction. Naltrexone blocks the euphoric and pain-relieving effects of heroin and most other opioids. This type of medication-assisted treatment does not have addictive properties, does not produce physical dependence, and tolerance does not develop. Unlike methadone or Suboxone, it has several disadvantages. It does not suppress withdrawal or cravings. Therefore, many patients are not motivated enough to take it on a regular basis. It cannot be started until a patient is off of all opioids for at least two weeks, though many patients are unable to maintain abstinence during that waiting period. Also, once patients have started on naltrexone the risk of overdose death is increased if relapse does occur.
Buprenorphine / Subutex / Suboxone
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, 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.
What Is Medication-Assisted Treatment?
Medication-assisted treatment for opioid dependence can include the use of buprenorphine (Suboxone) to complement the education, counseling and other support measures that focus on the behavioral aspects of opioid addiction. This medication can allow one to regain a normal state of mind – free of withdrawal, cravings and the drug-induced highs and lows of addiction. Medication-assisted treatment for opioid addiction and dependence is much like using medication to treat other chronic illnesses such as heart disease, asthma or diabetes. Taking medication for opioid addiction is not the same as substituting one addictive drug for another.
What Is Suboxone and How Does it Work?
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.
What Is a ‘Partial Opioid Agonist’?
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.’