Suboxone for Opiate Detox and Long Term Therapy
A newer and much preferable alternative to methadone maintenance therapy for the treatment of opiate addiction is Suboxone therapy. Suboxone therapy can be used to help addicts overcome the initial pains of withdrawal safely and humanely, and can also be used as a long term form of opiate replacement therapy.
Synopsis
What is Suboxone?
Suboxone is composed of two active ingredients, buprenorphine and nalexone. Buprenorphine is a partial opiate agonist and it binds to the same receptors in the brain that drugs like heroin or narcotic pain pills do. Since the buprenorphine binds to these same receptors, the brain doesn’t notice that you have stopped taking the drug of abuse, and you feel no withdrawal pains.
Buprenorphine
Buprenorphine is only a partial agonist though, and although it does bind to these same receptors, it offers little euphoria and little of the high that becomes so problematic with the abuse of pain pills or heroin. Users, once switched to buprenorphine, can once again participate normally in society, free from the pains of withdrawal and also free from intoxication.
Nalexone
The other active ingredient, nalexone, is incorporated to increase the safety of the drug by lowering the likelihood of abuse. Although buprenorphine does not readily induce a high, if injected in quantity and especially if combined with a tranquilizer type drug, it can be abused. Nalexone is an opiate antagonist, and if you take nalexone you cannot feel any opiate pleasure, and you go into immediate and very intense withdrawal.
Suboxone is taken sublingually (under the tongue) and when taken as directed your body does not absorb much of the nalexone, and you do not feel these withdrawal inducing effects; but were you to try to abuse it though injection administration, not only would you not get high, you would enter into severe detox pains almost immediately.
Because the drug has a much lower abuse potential than methadone, recovering addicts are not required to come to a clinic to take their dose under supervision, and can be prescribed a month's supply of the pills, purchasable at approved pharmacies.
A second advantage to suboxone over methadone relates to the eventual need to detox off of the replacement opiate. Doctors and critics have long questioned the value of methadone replacement therapy, arguing that although addicts can live better lives while on methadone, the eventual detox that they are forced to endure is actually worse and longer lasting than the detox off of heroin!
Suboxone is an opiate, and all opiates do require a period of eventual withdrawal, but the pains of withdrawal off of suboxone are nowhere near as intense as heroin, and far easier than with methadone. The detox off of suboxone seems to intensify the longer the medication is used, and if suboxone can be used as a brief transitional medication, withdrawal pains are very manageable.
Suboxone, for Detox and for Long Term Therapy
The Two Ways Suboxone Is Used
Recovering opiate addicts may use suboxone in two ways. They may choose to use it in a manner similar to methadone, and take the pills as a long term replacement solution, or they may use it as a way to ease the pains of cold turkey detox, and only take the suboxone for a week or more.
Long Term Replacement
Basically, it's just a better methadone. You can function as normal, you feel yourself again, and you feel neither high nor feel the pains and agony of detox and withdrawal. You can be prescribed enough pills for a month or more, and you do not need to expend such energy and time getting to a central methadone clinic for your daily dose.
The side effects are minor, and a small price to pay for a better life free from addiction, and although the eventual detox can be tough, it's far easier than for methadone and nowhere close to the agony of an abrupt cessation of narcotic pain pills or heroin.
You can’t abuse it, and if you follow the directions of use, it is very safe.
Easing the Pains of Withdrawal
You may also wish to consider suboxone as a way to ease the transition off of drugs such as heroin or narcotic pain pills. A legitimate fear of the pains of detox can be a significant motivator to continuing use, and far too many people remain addicts just to avoid a week of detox agony. Suboxone can help, and a suboxone detox is far more humane; and because it's not as painful a lot more people can endure the detox period and break free from addiction.
It should be done under medical supervision, and ideally under constant observation as in a residential rehab or sequestered detox clinic. Medical staff will wait until you are feeling the initial and intense pains of withdrawal before administering a dosage of suboxone. The suboxone will immediately arrest all painful withdrawal symptoms, and allow the patient to stabilize in recovery and transition off of the drug of abuse. After a day or so the suboxone dosage will be gradually tapered down, until it is stopped completely about a day before the end of detox.
The detox is not pain free, as since suboxone is an opiate it does carry a syndrome of withdrawal, but the symptoms of withdrawal off of suboxone are far less intense and severe than with comparable opiates, and can be more readily handled by patients in detoxification.
At the end of a period of detox, patients are advised to enter into intense residential or outpatient therapies of relapse avoidance, to ensure that whatever caused the drug seeking behaviors in the first place does not provoke a need for another painful period of addiction and necessary detox.
Suboxone Side Effects and Problems
Side Effects
Suboxone is very well tolerated by the vast majority of patients. Some people may experience some minor side effects, including:
- Nausea
- Headache
- Sleepiness
- Dry mouth
- Sexual dysfunction
- Urinary retention
- Dizziness and others
The risks of overdose are low, but as it is an opiate it can cause respiratory depression when taken to excess, and can be quite dangerous if taken in conjunction with alcohol, sedatives, tranquilizers, or any other form of CNS depressant medication.
In very rare occasions, patients have reported a hypersensitivity to the nalexone in the medication. The nalexone, which normally if the medication is taken as directed has no effect, in these patients with a hypersensitivity does cause a reaction, and does induce a severe period of withdrawal. This is very rare.
It is quite easy to transition off of short acting opiates of abuse such as heroin, hydrocodone or oxycontin onto suboxone, but it can be quite difficult to transition from longer acting opiates such as methadone. Patients addicted to methadone and wanting to switch to suboxone will generally transition between the two medications via a period on a drug such as oxycontin.
Problems
Suboxone is a vastly preferable alternative to methadone is just about every way. The eventual detox off of the suboxone is easier, you don’t need to go to a clinic to take you dosage, and it's not nearly as easily abused.
User reports on the effectiveness of suboxone have been filled with praise, and although many do note that there can be a serious syndrome of detox side effects if used over a long period, most recovering addicts who have endured this still recommend its usage.
In America, the two greatest problems regarding the use of suboxone are availability and cost.
Doctor's must receive special certification before achieving licensing to prescribe the drug, and there are simply not enough doctors who may give it. Additionally, current legislation caps the numbers of patients each doctor may prescribe suboxone to, further compounding the problem.
Secondly, the drug remains quite expensive, and for those without adequate private health insurance or without the means to self finance the drug, it can be prohibitively expensive.
No More Methadone
With suboxone's successful arrival, there is no longer any real reason to consider methadone maintenance therapy, unless you are unable to access or afford suboxone.
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