Is Suboxone an Opiate? And Your Other Detox Questions, Answered

Ready to detox off heroin or pain pills? We give you basic info about buprenorphine/naloxone, commonly called by popular brand name, Suboxone.

Making the decision to detox from opiates is described by Workit staff member and former user Kali, as “an easy choice, a logical decision, (that) has suddenly become the most difficult of my life.” Maybe you’re reading this article because you are in the process of making that decision, or maybe you already have. If so, congratulations! But with this decision comes many questions. Fear not, that’s what we are here for. Let us take some of that weight off your shoulders.

1. Is Suboxone an opiate?

Quite literally, yes it is¹. Heroin operates by binding opioid receptors in your brain, spinal cord, or stomach. This receptor binding causes euphoric pain relief. The main ingredient of Suboxone is buprenorphine, and it operates by occupying those same receptors, therefore competing with anything (like heroin) that can bind these receptors. Any substance than binds those receptors and produces even the slightest high, is by definition, an opioid². These substances include heroin, morphine, methadone, buprenorphine, hydrocodone, and oxycodone. Buprenorphine is the weakest of these substances, producing a minimal high.

Bottom Line: Yes, Suboxone is an opiate, but it produces a minimal high.

2. So what’s the difference between an opiate and an opioid?

An opiate is a drug derived from opium. Synthetic opiates have been referred to as opioids, but now the definition of opioid has expanded. In the medical community, opiate still tends to refer to substances directly derived from opium. At Workit, we have recovered addicts on staff who used the terms interchangeably in the past, and we continue to do so to speak to the community.

Bottom Line: At one time, opiates were drugs made from opium and opioids were synthetic opiates. Now? The two terms are interchangeable.

3. But isn’t the purpose of these drugs to help me stop taking opiates?

Yes, most certainly. Suboxone operates by binding the opioid receptors to prevent withdrawal while producing a minimal high, therefore helping to prevent against any recreational use. This binding helps individuals stop their heroin or pill habit by reducing cravings. With time, Suboxone doses can be lessened and lessened to the point where an individual is no longer reliant on any opiates. Consider Suboxone as the safe intermediate in the middle of your path to recovery.

Bottom Line: Taking Suboxone, a weak opiate, can help you get off the stronger stuff while avoiding bad withdrawal. Always take in conjunction with counseling & psychosocial support.

4. What’s the difference between Suboxone and buprenorphine?

Good question! Suboxone contains buprenorphine and naloxone. Buprenorphine is a partial agonist, meaning it occupies the same opioid receptors as heroin but doesn’t produce the same high. Naloxone (better known as Narcan) is an antagonist, meaning it blocks the receptors and produces absolutely no high. The naloxone prevents Suboxone from being severely abused. Buprenorphine alone does have abuse potential because it can produce a high.

Bottom Line: Suboxone is buprenorphine with naloxone added to it to prevent severe abuse potential.

5. What’s the difference between Suboxone and methadone?

Drugs called full agonists bind opioid receptors at a high frequency and result in heavy euphoric feelings. Methadone is a full agonist. Partial agonists also bind these receptors, but their effects are less pronounced. Buprenorphine is a partial agonist. Finally, antagonists bind the receptors and turn them off by preventing anything else from binding. Suboxone is 80% buprenorphine, so it is mostly a partial agonist, but it’s also 20% naloxone. The naloxone component exists to prevent users from abusing the drug to achieve highs.

You can safely transition from methadone to Suboxone. At Workit Health, we recommend a slow taper to 30mg of methadone for 2 weeks before beginning Suboxone treatment.

Bottom Line: Methadone works differently in your brain, and has a higher misuse potential than Suboxone.

6. How long will it take me to get off of Suboxone?

The scientific results of this topic are somewhat mixed. One study shows that a full Suboxone taper is very difficult with only 9% of the study’s participants fully completing the taper and remaining opiate free³. However, another study found great success with the tapering process with 60% of participants prescription opiate free after 40 months⁴.

In Workit Clinic, each member’s dose and duration on medication is planned by their medical team.

In Workit Clinic, each member’s dose and duration on medication is planned by their medical team.

In addition to medication, members enjoy access to educational content and messaging with a coach team for recovery support. Why? Because your addiction doesn’t take breaks; and neither do we.

Bottom Line: Tapers vary in length, and always need to be completed under medical care. Contact Workit Clinic if you’re ready to make a change.

7. What are the side effects of long term Suboxone use?

Some individuals decide to continue to use Suboxone in the long term. One study has shown that Suboxone (compared to other opioid medicines) can help a person regain their once productive and social states⁵. Another study found that Suboxone use lead to forms of minor emotional blunting⁶. If consumed with alcohol or benzodiazepines, the outcome can be fatal. In some cases, individuals have reported headache, pain, withdrawal syndrome, infection, insomnia, back pain, and constipation. It has been shown that, in general, a switch to Suboxone results in an improvement in overall health.

Bottom Line: As with any drug, Suboxone has side effects. But it can help you kick an opiate addiction.

8. Will Suboxone show up on a drug test?

It will not show up on a standard drug test, unless your employer specifically tests for buprenorphine, the main ingredient in Suboxone. Remember that just because Suboxone is an opiate, however, doesn’t mean it’s unsafe or not okay to take as prescribed.

Ali Safawi goes into this in more detail in an article where he explains, “The opioid ingredient in Suboxone, buprenorphine, will not show up in an opioid drug test unless you are taking a multi-panel test which specifically tests for buprenorphine. Even then, if you are being prescribed Suboxone, you shouldn’t have to worry about a positive test buprenorphine test.”

9. What can happen if I decide to just stop taking opiates all together?

A sudden cessation of opiates can result in withdrawal. Nausea, muscle cramping, depression, agitation, anxiety, and opiate cravings characterize withdrawal. While the withdrawal process itself may not be life-threatening, it will lead to intense opiate cravings, which could lead to an overdose scenario. Suboxone prevents the withdrawal from happening and will decrease the cravings.

Bottom Line: Anyone who has tried to quit opiates cold turkey knows this bottom line already. Opiate withdrawal can be rough. Suboxone might be able to help.

To again quote our staff member and recovered opiate addict: “A pill habit lands you in a world where it’s all under control, until it’s suddenly, desperately not.” The first step to regaining control is making the decision to detox. One of the most important parts of this action is to make sure you do it in a safe, clinically effective manner.

 

 

  1. Lutfy, K., & Cowan, A. (2004). Buprenorphine: A Unique Drug with Complex Pharmacology. Current Neuropharmacology, 2(4), 395–402. http://doi.org/10.2174/1570159043359477

  2. Opiate vs. Opioid – What’s the Difference? (n.d.). Retrieved July 16, 2017, from http://opium.com/derivatives/opiate-vs-opioid-whats-difference/

  3. Weiss, R. D., Potter, J. S., Fiellin, D. A., Byrne, M., Connery, H. S., Dickinson, W., … & Hasson, A. L. (2011). Adjunctive counseling during brief and extended buprenorphine-naloxone treatment for prescription opioid dependence: a 2-phase randomized controlled trial. Archives of general psychiatry, 68(12), 1238-1246.

  4. NIDA. (2015, November 30). Long-Term Follow-Up of Medication-Assisted Treatment for Addiction to Pain Relievers Yields “Cause for Optimism”. Retrieved from https://www.drugabuse.gov/news-events/nida-notes/2015/11/long-term-follow-up-medication-assisted-treatment-addiction-to-pain-relievers-yields-cause-optimism on 2017, July 12

  5. Fudala, P. J., Bridge, T. P., Herbert, S., Williford, W. O., Chiang, C. N., Jones, K., … & Ling, W. (2003). Office-based treatment of opiate addiction with a sublingual-tablet formulation of buprenorphine and naloxone. New England Journal of Medicine, 349(10), 949-958.

  6. Hill, E., Han, D., Dumouchel, P., Dehak, N., Quatieri, T., Moehs, C., … & Blum, K. (2013). Long term Suboxone™ emotional reactivity as measured by automatic detection in speech. PLoS one, 8(7), e69043.

Subutex, Suboxone, and the History of Buprenorphine

Subutex, Suboxone, and buprenorphine, oh my! What do all these names mean?

We recently answered some questions about Suboxone. But we left one off the list. What is Subutex? How is it different that Suboxone? And why aren’t we hearing about it anymore?

The short answer? Subutex was a sublingual form of buprenorphine made by the company that manufactures Suboxone now. Let’s look at Subutex, Suboxone, and the evolution of buprenorphine:

The History Of Buprenorphine

Buprenorphine, sometimes called bupes on the street, was discovered in 1966, at a home products company Reckitt and Colman. They believed that “opioids with structures substantially more complex than morphine could selectively retain the desirable actions whilst shedding the undesirable side effects,” and their main goal was to find such an opioid. They had two failed attempts before finally putting buprenorphine into clinical studies. When presented at major conferences, buprenorphine was attractive to many pharmacologists because it was seen as an effective pain killer that didn’t have a high abuse potential, and it also had potential as a drug treatment for narcotic addiction. Despite this realization it took almost three decades for it to be used therapeutically.

The bottom line: Buprenorphine was discovered in 1966 as an alternative to morphine with potential to treat narcotic addiction. It took 30 years to put this potential into practice.

Reckitt Develops Subutex

This sublingual form of buprenorphine was manufactured by Reckitt and was released in 1995, first in France, in response to the AIDS epidemic among heroin injection users. In 2002, it received FDA approval in the United States. Subutex contains just buprenorphine, so it was prone to diversion. By 2012, Reckitt would cease the production of Subutex (not for safety reasons).

The bottom line: Subutex was a sublingual brand name form of buprenorphine, designed to treat heroin addiction. It had high abuse potential.

Buprenorphine + Naloxone = Suboxone

In 1993, the National Institute on Drug Abuse approached Reckitt about developing a combination tablet that could help prevent the problem of buprenorphine and methadone diversion. In 2002, Suboxone, the response to the request, received FDA approval. Suboxone contains both buprenorphine and naloxone, a full agonist that can help prevent users from injecting Suboxone to get high.

The bottom line: Suboxone is buprenorphine with an ingredient added that limits abuse potential. It is currently the gold standard of medication-assisted treatment.

Always take in conjunction with counseling & psychosocial support. See below for our recommended Gold Standard of Care.

 

 

Medication Assisted Treatment in the Opioid Crisis

What is Medication Assisted Treatment?

Medication Assisted Treatment (MAT) is the treatment of opioid use disorder with agonists like Suboxone or methadone. The tremendous stigma already established against addictive behavior makes it an easy target for critics. This stigma remains despite the fact that “scientific research has established that medication-assisted treatment of opioid addiction increases patient retention and decreases drug use, infectious disease transmission, and criminal activity.”¹ Despite current stigma against MAT, we’re in the face of an opioid epidemic. It’s time to look at the facts in order to offer people the best care possible and save lives. This means we must consider both the scientific and socioeconomic aspects of treating substance use disorder (SUD).

What does the science say about the effectiveness of buprenorphine treatment?

Cozzolino et al. looked at buprenorphine treatment in Italy over a 3 year period. Of the 131 patients who previously received methadone treatment with an inadequate dosage, 60 patients remained in treatment (46%), 31 dropped out (24%), 13 shifted to methadone (10%), 16 completed treatment (12%), 8 went to prison (6%), and 3 were transferred to other services (2%). Also, 80% of the collected urine samples were negative for opioids.²

An interesting 2015 study looked at the efficacy of a Suboxone taper as a treatment option. While the people who received a long-term taper initially had positive outcomes (nearly 50% were abstinent by the last four weeks of therapy), that success immediately collapsed once they ceased MAT. Fewer than 10% were doing well at the end of their two month follow up. However, an interview of 300 of the participants 30 and 42 months later revealed that over half had regained their abstinence. This may have something to do with the fact that many of the patients “re-engaged in opioid agonist therapy.” In fact, at the 18 month follow-up mark, those who were still using MAT were more than twice as likely to report abstinence as those who weren’t utilizing MAT (80 percent versus 37 percent).

This study shines a light on the topic of MAT. While detoxification has yet to perfected, maintenance on Suboxone is effective for many individuals. It has been shown that Suboxone can help individuals remain socially functional, especially in terms of regained productivity.⁴ The research telling us to consider MAT is there.

MAT can help in residential treatment.

Just how effective are residential rehabilitation programs (also referred to as therapeutic communities)? The results on these programs are some what mixed and notoriously difficult to judge. In a 13 month study by Keen et al., the researchers found that the mean stay was 80 days, and that 87.5% of the program participants failed to achieve abstinence. 65% of patients who received in-house detoxification finished the detox program. However, upon departure, 68.1% were classified as failures and only 12% were classified as successes, meaning they either completed their treatment or had planned departures/transfers.

Residential treatment for all SUDs can be an extremely effective treatment option under intense circumstances. Dupont (2009) looked at a program offered to physicians with SUDs. A five-year rehabilitation plan involving intensive treatment, extended support from the patients’ families, employers, and colleagues resulted in 71% of the doctors remaining licensed and employed at the five year mark.⁶ Programs like this have popped up recently, providing long term support and a residential enclave of supportive staff and patients. Unfortunately, reality and its requirements keep most of the population from having the privilege of being swept away from responsibilities and into a separated facility. Not everyone has supportive families, employers, or colleagues.

A controlled study by Gossop et al. compared inpatient to outpatient outcomes. In this experiment, individuals were given a choice of their group and those who had no preference were randomly assigned. Taken all together, the inpatient group did do significantly better. However, the researchers also found that people with their preferences met tend to do better: 53% of the patients in the preferred group completed withdrawal compared to 35% of patients in the randomized group. This indicates that perhaps the success of a treatment depends on the will of the patient. It is also worth noting that, unlike other studies, this study did not provide outpatient individuals with intensive methods like community availability.⁷ Those who get their needs met, succeed. We should meet those needs in any way possible.

Treatment cost often stands in the way.

And what’s a huge hang-up to meeting a client’s needs, especially in this climate of healthcare uncertainty? A huge, deciding factor in treatment is cost. Roebuck, et al. (2003) did a cost analysis on SUD treatment options and found that the mean weekly cost of Methadone Maintenance (a form of MAT) is $91 for 99 weeks, a total of $9,009 (the Workit Clinic program is an affordable MAT option). On the other hand, the average weekly cost for long-term therapeutic communities is $587 with no medication-assisted treatment included. This is for an average of 33 weeks (a total cost of $19,371)⁸. The per capita income of a Michigan Resident is $26,607, or $511 a week⁹. These figures clearly show that residential care is simply not affordable for the average citizen. Suboxone can clearly help individuals to be more productive and more socially successful. Why should we stop individuals who can’t afford residential treatment from retaking control of their lives?

“The average cost for long-term therapeutic communities is $587 per week. The per capita income of a Michigan resident is $26,607 or $511 per week.”

Which works better—Inpatient care or MAT?

Regardless of which treatment style is “better” than the other, two things are clear: both methods can be effective, and one treatment is significantly less expensive than the other. It is also important to restate that some individuals with substance use disorder may have a preference of treatment. At Workit Health, we believe that increasing the availability of MAT along with psychosocial care will have a positive impact. Let’s give people as many opportunities for success as possible! Especially if studies show they do better when they get what they want. Not everyone can afford residential treatment, not everyone can afford to take time away from family and work, and not everyone can afford to sit on a waitlist.