Suboxone (naloxone and buprenorphine) is a Schedule II controlled substance that can be prescribed only by approved physicians.
Some rehabs may use Suboxone for withdrawal management from opioids and the treatment of pain if they have a qualified physician on staff.
Suboxone is a combination of two medications: naloxone and buprenorphine.
Naloxone is an opioid antagonist medication that is used in the treatment of opioid overdose, and its presence in Suboxone is designed to limit the abuse of the drug. If a person attempts to grind up Suboxone pills, the naloxone is activated, and the person will undergo opioid withdrawal; otherwise, the naloxone is not activated.
The active ingredient in Suboxone is buprenorphine, a partial opioid agonist that can be used to treat issues with pain and is useful in the treatment of opioid withdrawal. People in physician-assisted medical detox programs to address opioid withdrawal (withdrawal management programs) can benefit from Suboxone to totally reduce or significantly limit their withdrawal symptoms in the early stages of recovery.
The guidelines for prescribing Schedule II opioid drugs are established by the DEA and the Substance Abuse and Mental Health Services Administration (SAMHSA). Physicians must undergo specialized training and meet certification requirements to prescribe these medications.
After completion of the requirements, a physician is given a Schedule II DEA prescription license to prescribe opioid drugs within this classification. Any physician with this license can prescribe Suboxone.
Unlike methadone, Suboxone may often be prescribed to individuals for home use. Rehabs that utilize medical detox facilities for the treatment of opioid use disorders and have a qualified physician on staff may use Suboxone.
According to SAMHSA:
The majority of these individuals were most likely prescribed the medication for recovery from opioid abuse or for the control of chronic pain. Moreover, the majority of individuals admitting to misusing buprenorphine most likely did not misuse Suboxone. Instead, it is more likely than other forms of buprenorphine were misused in these cases.
Under the Affordable Care Act (also known as Obamacare), increased availability of Medicaid was associated with an increase in the use of Suboxone. This is most likely due to increased prescription rates of Suboxone for the treatment of opioid use disorders in community mental health centers and other facilities that accept Medicaid insurance.
Suboxone is considered to be an opioid replacement medication, meaning that it can be used in place of more potent opioid drugs, including heroin, morphine, Vicodin, and others.
It is a partial opioid agonist, which means that it attaches to the neurons in the brain that are specialized for opioid drugs, but it does not produce the same effects that other opioid drugs produce. When you take Suboxone, you will not experience withdrawal from other opioids you may have been abusing. Thus, it is typically used in the medical detox process to help people in the early stages of recovery from opioid abuse.
If you are recovering from opioid abuse and are prescribed Suboxone in rehab, there are some things you can expect such as the following:
Just because you got through the withdrawal process does not mean that you are “cured” of your opioid addiction. There is no cure for addiction.
Instead, you will continue into a treatment program after medical detox is complete. This program will consist of therapy, support group participation, and other interventions as identified by your treatment providers.
Research studies indicate that Suboxone is extremely effective in helping individuals get through detox without experiencing withdrawal symptoms from their opioid of choice. As a result, it is associated with significantly lower rates of relapse during the early stages of recovery.
Some research studies have found that nearly 75 percent of individuals on buprenorphine had negative urine drug screenings a year following medical detox, whereas none of the patients using a placebo during withdrawal had negative drug screenings. The use of buprenorphine also significantly lowers mortality rates for opioid abusers in recovery.
The reasons why buprenorphine is not prescribed more often are that many physicians have not fulfilled the qualifications to prescribe it and those who have the qualifications to prescribe buprenorphine (the active ingredient in Suboxone) may not prescribe it often enough. While it’s not a cure-all for opioid addiction, it can greatly help the recovery process in some instances.
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(February 2018) Suboxone. RxList. Retrieved April 2019 from from https://www.rxlist.com/suboxone-drug.htm
(March 2019) Legislation, Regulations, and Guidelines. Substance Abuse and Mental Health Services Administration. Retrieved April 2019 from from https://www.samhsa.gov/medication-assisted-treatment/legislation-regulations-guidelines
(October 2018) National Survey on Drug Use and Health: Detailed Tables. Substance Abuse and Mental Health Services Administration. Retrieved April 2019 from from https://www.samhsa.gov/data/sites/default/files/cbhsq-reports/NSDUHDetailedTabs2017/NSDUHDetailedTabs2017.pdf
(August 2018) Suboxone Use Increased in Medicaid-Expanding States. Pharmacy Times. Retrieved April 2019 from from https://www.pharmacytimes.com/news/suboxone-use-increased-in-medicaidexpanding-states
(Spring 2018) Suboxone: Rationale, Science, Misconceptions. The Ochsner Journal. Retrieved April 2019 from from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5855417/
(July 2017) Why aren't physicians prescribing more buprenorphine? Journal of Substance Abuse Treatment. Retrieved April 2019 from from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5524453/