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What Level of Suboxone Use Is Abuse?

Suboxone is a medication that is prescribed to help manage opioid dependence. Opioid addiction in the United States is at epidemic levels. The U.S. Department of Health and Human Services (HHS) reports that nearly 11.5 million Americans misused a prescription opioid in 2017, and more than 2 million people struggled with opioid addiction. Suboxone is one of the common medications approved to treat opioid dependence, and per the Drug Abuse Treatment Act of 2000, it can be prescribed out of a private office by licensed medical professionals.

As a combination medication, Suboxone contains one part naloxone and four parts buprenorphine and is dispensed as a sublingual film strip. This strip is placed under the tongue and dissolved.

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The buprenorphine component of Suboxone is a partial opioid agonist and, therefore, has the potential for abuse. The National Survey on Drug Use and Health (NSDUH) reports that about 0.3 percent of the American population misused a buprenorphine product in 2016.

The naloxone component is an opioid antagonist, and if Suboxone is abused (or combined with a full opioid agonist), this substance is activated and can cause significant withdrawal symptoms. Suboxone is designed to deter abuse, but it can still be misused. Use outside of a legitimate and necessary prescription is a form of drug abuse.

Standard Suboxone Dosing

 

Suboxone is designed to be taken as part of an opioid dependence treatment program that should also include therapeutic methods, counseling, and support groups within a full continuum of care. Suboxone treatment can fall into three different types: the induction phase, the maintenance phase, and the tapering phase. Induction is the initial dosage of Suboxone that will be given by a medical professional in a dosage that is recommended for the specific person. Dosage will vary from person to person, as things like the level of opioid dependence and other biological factors can play a role in how much will be required.

Suboxone film strips come in the following dosage amounts:

  • 2 mg buprenorphine/0.5 mg naloxone
  • 4 mg buprenorphine/ 1 mg naloxone
  • 8 mg buprenorphine/ 2 mg naloxone
  • 12 mg buprenorphine/ 3 mg naloxone

Generally speaking, Suboxone will be initiated after all full opioid agonists have fully cleared the system to avoid interaction with naloxone and the precipitation of withdrawal. The dosage typically starts with between 2 mg and 4 mg of buprenorphine on the first day, which is doubled the second day, and then upped to between 6 mg and 12 mg the third day. Once a person is stabilized after the first few days, the dosage may be adjusted within 2 mg in either direction to find a maintenance dose that is effective at keeping withdrawal symptoms and cravings to a minimum without causing intoxication.

Suboxone is commonly taken only once or twice a day. When attempting to stop taking Suboxone, the drug is to be tapered off. This is usually done slowly over a period as the dosage is lowered by 2 mg every few days as tolerated.

 

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When Use Is Abuse

Any time Suboxone is taken in doses higher than prescribed, or if it is taken in between doses, it is considered misuse. If a prescription calls for one 12 mg/3 mg film strip to be taken once per day and the person takes two at a time or takes an extra one that day, this is abuse. Any use outside of a prescription is considered recreational drug abuse and misuse of prescription medication.

The buprenorphine component of Suboxone that is the opioid is only a partial agonist. This means that while it does interact with the same part of the brain that full agonists like heroin and other potent opioid narcotic painkillers do, it only does so to a certain extent. For this reason, Suboxone does not produce the same euphoria associated with other opioids.

Buprenorphine’s effects also stop working at a certain point. It plateaus, and after this point, it will not cause any more euphoria, no matter how much more a person takes. Between this and the fact that the naloxone can actually induce cravings and flu-like withdrawal symptoms, combination buprenorphine/naloxone medications have a low potential for abuse.

Suboxone can still be abused, however. The medication can be hidden in clothing, taped to coloring pages or books, or hidden under postage stamps. It is smuggled into prisons and jails in a variety of creative ways since it is small and relatively innocuous looking, making it easier to sneak in than heroin or prescription pills. Suboxone doesn’t require drug paraphernalia to take it either; all you have to do is dissolve it in the mouth. No needles, syringes, or pipes are needed to ingest it.

Since Suboxone does not produce the same kind of high that other opioids can, it is likely to be abused by those who can’t get other opioids as a method of self-medication to manage withdrawal symptoms. Taking Suboxone without a prescription comes with many risk factors, including the possibility of overdose and addiction.

Tips for Identifying Problematic Suboxone Use

Again, as any use of Suboxone without a prescription is considered abuse, this would be the first indicator of problematic use. Additional signs that Suboxone use is abuse include the following:

  • Seeking out more prescriptions for Suboxone after a prescription has run out
  • Taking more Suboxone than is prescribed at a time or taking it in between doses
  • Going to more than one doctor to try and get multiple prescriptions of Suboxone
  • Suspicious packages coming in the mail since Suboxone may be ordered illegally online
  • Taking doses over 24 mg of Suboxone in a single day
  • Mood swings and out-of-character behaviors
  • Intoxication that can be similar to being drunk on alcohol, including slurred speech, impaired reflexes and coordination, drowsiness, and lowered inhibitions
  • Lack of interest in hobbies, recreational events, or social activities that were important before
  • High tolerance to Suboxone that requires escalating doses
  • Cravings for the drug and withdrawal symptoms between doses
  • Extreme focus on use
  • Going to great lengths to get more Suboxone, often through illicit channels

Suboxone contains an opioid drug, and as a result, individuals can build up a tolerance to the drug and also become dependent on it, just like with other opioids. Suboxone addiction is also possible as is a potentially life-threatening overdose.

The Importance of Safe Dosing

Suboxone is a controlled substance, and it is, therefore, tightly regulated and monitored. It should be administered under the watchful eye of a trained professional and only as part of a complete opioid addiction treatment program. Suboxone is often an important and beneficial component of an addiction treatment program, but it must be used correctly.