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THE USE OF SUBOXONE WITH OPIATE ADDICTION TREATMENTSuboxone has been approved for use with opiate addiction treatment. The active ingredient buprenorphine hydrochloride, reduces the symptoms of opiate dependence. Suboxone is a combination of two proven medications, buprenorphine and naloxone. Buprenorphine, a partial opioid agonist, reduces withdrawal symptoms and blocks the effects of subsequently administered opiates, suggesting it might help reduce illicit opiate use. Due to the presence of naloxone, Suboxone is very likely to produce severe withdrawal symptoms if misused intravenously. When used as prescribed, no such effect is likely. Suboxone is one of the first opiate addiction treatments approved for in-office prescribing under the federal Drug Addiction Treatment Act of 2000 (DATA). The Formula Suboxone®, a sublingual tablet, comes in two dosage forms: 2 mg buprenorphine/0.5 mg naloxone and 8 mg buprenorphine/2 mg naloxone. Safety Because of its ceiling effect and poor bioavailability, buprenorphine is safer in overdose than opioid full agonists. The maximal effects of buprenorphine appear to occur in the 16–32 mg dose range for sublingual tablets. Higher doses are unlikely to produce greater effects. Opiate Addiction Treatment with Suboxone ® This section provides a brief overview of the clinical use of buprenorphine (Suboxone®) for opiate addiction treatment. Ideal candidates for opiate addiction treatment with Suboxone® are individuals who have been objectively diagnosed with an opiate addiction, are willing to follow safety precautions for treatment, can be expected to comply with the treatment, have no contraindications to buprenorphine therapy, and who agree to buprenorphine treatment after a review of treatment options. There are four phases of Suboxone® therapy: induction, stabilization, withdrawal and treatment. Induction This phase is the medically monitored startup of buprenorphine therapy. Buprenorphine for induction therapy is administered when an opiate-dependent individual has abstained from using opiates for 12–24 hours and is in the early stages of opiate withdrawal. If the patient is not in the early stages of withdrawal, i.e., if he or she has other opioids in the bloodstream, then the buprenorphine dose could cause acute withdrawal. Induction is typically initiated as observed therapy in the physician's office and is carried out using Suboxone®. Stabilization This phase begins when the patient has discontinued the use of his or her drug of abuse, no longer has cravings, and is experiencing few or no side effects. The buprenorphine dose may need to be adjusted during the stabilization phase. Because of the long half-life of buprenorphine it is sometimes possible to switch patients to alternate-day dosing once stabilization has been achieved. Withdrawal The withdrawal phase is reached when the patient is doing well on a steady dose of Suboxone®. Once the patient shows no sign of opiate withdrawal, the patient is then titrated (stepped-down) from the buprenorphine therapy, until he or she is drug-free. This phase replaces what is otherwise known as "detoxification". Treatment Effective treatment of drug addiction requires comprehensive attention to all of an individual's medical and psychosocial co-morbidities. Pharmacological therapy alone rarely achieves long-term success. Thus Suboxone® therapy should be combined with concurrent behavioral therapies and with the provision of needed addiction treatment services. This point is of such importance that physicians must attest to their capacity to refer patients for addiction treatment and counseling when they submit their Notification of Intent to begin prescribing Suboxone® to SAMHSA (Substance Abuse and Mental Health Services Administration). For more information regarding the use of Suboxone® with opiate addiction treatment you may visit: You can also visit the SAMHSA Suboxone site at http://www.samhsa.gov
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