Opioid addiction affects an estimated 2.5 million people. Some triumph over their problem by abstinence, through organizations typified by Narcotics Anonymous or by redirecting their energies to a new passion. For many substituting less dangerous drugs for oral or injectable opioids reduces the potential for danger.
Suboxone and Subutex and their generic equivalents contain buprenorphine with or without naloxone. Most tablets and films are meant for daily application under the tongue or on the mucous membranes of the cheek. A monthly implant exists. The drug ranks among the most frequent prescriptions in the United States.
The buprenorphine component tightly sticks to and only partially activates the brain’s opioid receptor. This effectively prevents other opioids from fully activating the receptor and providing the feeling of euphoria. Topically applied naloxone offers no significant benefit. But it dissuades abuse of the buprenorphine. When injected naloxone displaces opioids from the receptor resulting in potentially severe withdrawal symptoms.
Suboxone and Subutex function as well as methadone but without the inconvenience of requiring daily attendance at a clinic. Buprenorphine may be dispensed in sufficient quantities for a month or longer. By law, physicians must be specially licensed to prescribe buprenorphine and may treat only a limited number of patients.
Treatment begins after mild withdrawal symptoms appear. Originally the first several doses were meant to be applied under direct supervision of a healthcare practitioner. An integral part of therapy involves education and counseling. Adherence to these rules no longer seems steadfast.
Originally treatment was intended to last up to a month. Experience quickly taught doctors that relapse with early discontinuation exceeded 90%. Even slow tapering over a year or so may be associated with a 25% failure rate. The underlying susceptibility to addiction remains lifelong and not uncommonly demands prolonged treatment.
Misuse of the drug especially Subutex appears increasingly common. Some doctors prescribe large quantities knowing patients will sell the excess hopefully using the funds to pay for return visits. Unfortunately addicts may use the money to acquire illicit drugs. Buprenorphine is frequently smuggled into prisons and used by inmates.