Suboxone: Basic and Essential Facts
What is Suboxone? Suboxone is the trade name for product that contains both Buprenorphine and Naloxone. Suboxone is only available as a sublingual film, but other companies are producing tablets that contain these two chemicals. Buprenorphine is an opioid with unique characteristics rendering it safer and stronger than other opioids.
What is Suboxone prescribed for? Suboxone is approved for the outpatient treatment of opioid dependency and it is also prescribed to treat pain as an off-label use. Some consider buprenorphine to be a mood stabilizer; however, the stabilizing effect might be due to bringing chemical dependency under control. It can be used to detoxify someone off of opioids or just maintain the opioid dependency safely. (See Buprenorphine: A Medicine for Addiction and Pain)
How is the film taken? Prior to taking the Suboxone film, the mouth should be moistened with water. The film is placed under the tongue to dissolve. It is best to sit forward in order to allow the saliva to pool around the strip. Without biting, chewing or swallowing, the film is allowed to dissolve undisturbed. Once it is completely dissolved, the saliva can be spit out. Swallowing is just more likely to upset the stomach and will not enhance the amount of chemical absorbed.
When should the film be taken? The initial dose should be taken in the presence of medical staff only after a mild to moderate amount of withdrawals are experienced following discontinuation of the previous opioid. (Usually within 24-48 hours of discontinuation.) Once initiated, twice or three time per day dosing may be necessary until the buprenorphine has had a chance to completely saturate the body. Steady-state, consistant plasma concentrations usually occur in the first week. Once stabilized, once a day dosing is usually sufficient to prevent withdrawal symptoms.
Are there other medications needed while on Suboxone to help with the transition? Sometimes transitioning onto Suboxone can be rough; thus, other medications can be prescribed to help with symptoms like nausea, anxiety, insomnia, and restlessness. Benadryl can help with both nausea and insomnia. Gabapentin can assist in blunting withdrawal symptoms like anxiety and restlessness. Doxepin also helps with anxiety, insomnia and restlessness. Other medications can also be helpful under the advice of a physician.
How does one get off of Suboxone? Getting off of Suboxone is often a very appropriate goal for an individual depending on the circumstances. Gradual tapering is best; although rapid tapering and sudden discontinuation can also be tolerable, again depending on the person and situation. For gradual tapering, stepping down by small increments every two weeks is very doable for most individuals. After each step down, mild restlessness or just feeling "off" is frequently experienced for a couple of days.
Are there alternatives to Suboxone? Buprenorphine is available without the Naloxone, as a generic medication or Subutex. However, buprenorphine is a desirable, abused chemical and caution is advisable. Because of Buprenorphine’s uniqueness, there is no other opioid that can compare to it.
Christina Lasich, M.D., wrote about chronic pain and osteoarthritis for HealthCentral. She is physiatrist in Grass Valley, California. She specializes in pain management and spine rehabilitation.