Photo courtesy of The National Alliance of Advocates for Buprenorphine Treatment
Question: Why take Suboxone (Buprenorphine/Naloxone)?
Suboxone (Buprenorphine/Naloxone) allows you to change the conditions in your life that led to opioid addiction. It allows you to focus on the problem that is the main cause of your addiction without exerting all of your energy to fight the cravings and withdrawal.
Question: How does Suboxone (Buprenorphine/Naloxone) work in the brain?
Opioids are any drug derived from, or synthesized to emulate, opium. Examples are; Morphine, heroin, Hydrocodone, oxycodone and methadone, among others. Opioids attach to receptors in the brain, with three main effects; reduced respiration, euphoria, decreased pain. The more opioids ingested the more of an effect. As a person increases their daily intake the brain actually changes and produces more opioid receptors. This is why it takes more opioids for the same effect as the dependence progresses. The process of opioids binding to the opioid receptors can be thought of as a mechanical union, the better the fit the more the opioid effect. Suboxone (Buprenorphine/Naloxone) binds to the receptors, however, without a perfect fit. As a result the Buprenorphine tends to occupy the receptors without as much of the opioid effect. The receptor is tricked into thinking it has been satisfied with opioids. This in turn prevents that receptor from joining with true opioids. Suboxone (Buprenorphine/Naloxone) tends to stay with the receptors, blocking them, much longer then opioids do. This stickiness, is what makes Buprenorphine last so long, up to 3 days.
Question: What is the ceiling effect
This is the limiting effect of the euphoria. Because of the imperfect fit of the Buprenorphine and the receptor, there is a limit as to the opioid effect one receives. With most patients this occurs at about 12-16mg. As you increase dosage beyond the ceiling you will notice no difference in euphoria.
Question: Will I go through withdrawal?
This depends on the level of your dependence. Your doctor will assess your dosage according to the length and level of your addiction. Most patients report little or no withdrawal symptoms as they transition from opioids to Buprenorphine. While taking Suboxone (Buprenorphine/Naloxone), you will experience a mild opioid effect. The transition off Buprenorphine can be gradual with patients reporting mild withdrawal symptoms.
Question: What is the biggest danger with taking Suboxone (Buprenorphine/Naloxone)?
There have been cases where patients taking benzodiazepines or other central nervous system depressants, such as alcohol, with Buprenorphine have died. These have been with patients that were injecting large doses of benzodiazepines and while injecting Subutex. The biggest danger, however, is situational; Since Buprenorphine Blocks the receptors, it will not allow opioids ingested to attach to receptors. Here's what could happen; A patient begins Buprenorphine treatment; soon after they have a relapse. They take heroin, they will not notice any effect due to the blocking effect. They may wrongly assume that the heroin they just purchased was bad, or of lower quality. They put the rest away. They stop Buprenorphine treatment for several days. Then they take the rest of the heroin they mistakenly thought was less then their usual purity. They overdose and die.
Question: What does the Naloxone do?
Naloxone causes immediate withdrawal in opioid dependent people. Under normal conditions, the Naloxone has no effect. It is not absorbed when taken under the tongue. It can only get into your body if it is injected or crushed and inhaled. The Naloxone is there to prevent Buprenorphine abuse and diversion to the street, by rendering it virtually non-abusable.
Question: How long should I stay on Suboxone (Buprenorphine/Naloxone)?
This varies from patient to patient, as a general rule, as long as it takes. There is much debate over this. It could be as little as a week, allowing just enough time to get past the withdrawal. Other people have been on Suboxone (Buprenorphine/Naloxone) maintenance for years. This needs to be decided by you, your doctor and your counselor.