Suboxone, which combines the medications buprenorphine and naloxone, is a drug used in medication assisted treatment (MAT) for drug addiction to opiates (like heroin) or opioids (like prescription painkillers). Like suboxone, methadone helps diminish withdrawal symptoms and drug cravings and is used in MAT programs to treat opioid and opiate addiction. Suboxone is somewhat different from methadone due to its key added ingredient — naloxone.
Approved for this use by the Food and Drug Administration (FDA) in 2002, suboxone is a dissolvable oral tablet or oral film that is classed as a “partial agonist” drug, which means that it only partially activates the opioid receptors in the brain, so the patient isn’t likely to get as “high” from this drug. A full agonist, on the other hand, fully stimulates the opioid brain receptors and delivers the full opioid effect — making it more likely to give the patient a “high” or elevated sense of well-being and, thus, more likely to be abused. Substances that are classed as “full agonist” drugs include opium, the opiate heroin, and prescription opioids like hydrocodone, oxycodone, morphine and fentanyl, among others.
Understanding Suboxone and How It Works
One of the components of suboxone is buprenorphine, an opioid medication that is also a partial agonist. It activates the opioid receptors in the brain, but is much less stimulating than a full agonist. Why use it to treat someone who is already addicted to opioids or opiates? Buprenorphine also acts as an antagonist, which means that it blocks the effects of other opioids. The idea is that buprenorphine allows for just enough opioid effect to help diminish withdrawal symptoms and drug cravings to prevent relapse. Naloxone, the other component of suboxone, is classed as an antidote. Used to treat opioid overdose in emergency situations, it completely blocks or reverses the effects of opioid medication, including the symptoms seen with overdose, such as slowed breathing and extreme drowsiness or loss of consciousness. Naloxone is an antagonist drug — it attaches to the opioid receptors and prevents them from being activated by opioids. In this way, naloxone deters people from crushing, injecting or otherwise attempting to misuse suboxone. If an individual tries to misuse suboxone, the naloxone in it will prevent them from attaining any euphoria. It will instead cause very unpleasant and severe withdrawal symptoms, and that is why naloxone has been added to suboxone.
Methadone vs. Suboxone
FDA-approved in the 1960s for treating heroin addiction, methadone is a full agonist, and the drug that was traditionally used in medically assisted opioid drug detox and rehabilitation settings before buprenorphine and suboxone were introduced. Like the buprenorphine contained in suboxone, methadone is an opioid. It changes the way the brain and the nervous system respond to pain in the body, and is used during opioid detox to diminish unpleasant withdrawal symptoms and drug cravings. Stronger than buprenorphine, methadone comes in tablets that can be swallowed or dissolved in water or juice. Why use suboxone instead of methadone? Because of the naloxone it contains, there is a lower risk of misuse and overdose when receiving suboxone for maintenance treatment. Although suboxone (due to its buprenorphine component) contains an opioid, this drug is not used for pain therapy. And, while not entirely safe, suboxone is generally considered safer than methadone. Methadone is still prescribed as a pain medication, and is also available on the black market. Methadone is highly addictive and methadone abuse and overdose are a concern. According to a recent report from the Centers for Disease Control and Prevention, roughly 30% of all painkiller deaths were attributable to methadone, or nearly one in four prescription opioid-related deaths. Additionally, methadone may cause a life-threatening heart rhythm disorder in some patients, so heart function will need to be monitored during methadone treatment.
Medically Assisted Treatment Approach
Both methadone and suboxone can lead to dependency, so as a legal requirement under the Drug Addiction Treatment Act of 2000, they are used with caution and under the supervision of an addiction specialist physician during medically assisted treatment (MAT). These addiction treatment medications can only be dispensed by an opioid treatment program that is certified by the Substance Abuse and Mental Health Services Administration and registered by the Drug Enforcement Administration. Because suboxone and other pharmaceuticals used in MAT can be habit forming, the MAT approach to addiction treatment is viewed by some as the replacement of one drug of dependency for another. Proponents of the MAT approach argue that the use of these drugs with consistent medical supervision is sometimes the only way to help an opiate-addicted person break free from their drug of abuse. They emphasize that pharmaceuticals used in MAT should not be viewed as replacements or substitutions for other drugs, but as part of a disease maintenance program. Regardless of whether a person uses suboxone or methadone, the addiction specialist who dispenses the maintenance drug used in their MAT will work with them on the length of treatment and will decide when to taper them off the drug under continued supervision. Sources: What’s this agonist / antagonist stuff? The National Alliance of Advocates for Buprenorphine Treatment. 2016. Methadone Prescribing and Overdose and the Association with Medicaid Preferred Drug List Policies — United States, 2007–2014. Mark Faul, PhD, et al. Morbidity and Mortality Weekly Report (MMWR), March 2017.