Since 2000, the United States has suffered an opioid addiction epidemic. Although narcotic drugs like heroin and morphine have been problematic for many people for several decades, the development of hydrocodone and oxycodone painkillers, and the wide prescription of these drugs to treat post-surgical pain or temporary pain from injury or illness, led more people to become addicted to opioids.
As of 2014, according to the Centers for Disease Control, 78 people per day die due to opioid overdoses. Deaths from prescription opioids in particular have quadrupled since 1999, the CDC notes.
In response to this problem, medical professionals have worked to change prescribing practices, and the Drug Enforcement Administration has changed the majority of opioid medications to Schedule II, with illicit drugs like heroin remaining Schedule I drugs. Pharmaceutical companies have also developed medications to help people struggling with opioid addiction to overcome physical dependence on the drugs while they seek help from rehabilitation centers. Methadone is the most famous maintenance medication, although it has a high rate of abuse and requires consistent supervision regarding dosing. Buprenorphine was developed as a prescription maintenance medication that allowed for more flexibility. Ideally, doctors prescribing buprenorphine work closely with patients as they overcome their struggle with narcotics while often taking part in an outpatient rehabilitation program. Two drugs developed with buprenorphine as their base are Subutex and Suboxone.
Although these two prescription medications are similar, and often used in conjunction with each other in maintenance and rehabilitation therapy, they are different medications and have different rates of abuse and addiction.
Subutex was approved as a prescription medication to help people struggling with opioid addiction overcome their substance abuse and dependency. It was approved for the market in 2002, with two dosages: 2 mg and 8 mg. This medication is no longer on the market. It was not removed, according to the Food and Drug Administration, due to reasons of effectiveness and safety, although those concerns had been raised due to a pattern of people with Subutex prescriptions beginning to abuse this drug.
Who Needs Subtex?
Subutex is the brand name for buprenorphine, in tablet form. This drug is a partial opioid agonist-antagonist, meaning it binds to the same brain receptors as narcotic drugs, so it can ease withdrawal symptoms as an individual begins to overcome physical dependence on opioid substances. It is considered a maintenance therapy for people who have struggled with opioid addiction for a long time.
How Is It Supposed to Be Used?
This medication was prescribed in either 2 mg or 8 mg doses, with the intention that the individual’s doctor should work with them over time to lower the dose gradually. This would prevent withdrawal symptoms.
How Is It Abused?
Unfortunately, buprenorphine and Subutex have become drugs of abuse, particularly among people who struggled with heroin addiction for a long time. People who become addicted to and abuse buprenorphine often grind up the tablets, mix the powder with water, and inject the solution intravenously, which allows for a rush of opioid-like sensations as the chemical binds quickly to the same receptors. The DEA seized buprenorphine as an illicit drug 10,804 times in 2012. The DAWN Report found that 21,483 emergency room visits involved nonmedical use of buprenorphine in some form.
Suboxone is a maintenance drug like Subutex, but instead of being just buprenorphine, Suboxone also contains naloxone. This new medication reverses the effects of opioids, and it has been particularly praised for helping emergency responders save people suffering from narcotic overdose.
Naloxone has a short half-life, so it typically does not last as long as other opioid drugs, but it will temporarily prevent these drugs from binding to the opioid receptors in the brain, so the person taking narcotics does not feel high. Suboxone was originally approved in 2002, like Subutex, but was approved in a different dose in 2010. Meanwhile, Subutex has been discontinued.
Who Needs Suboxone?
Suboxone was developed as a more foolproof maintenance therapy for people struggling to overcome addiction to narcotic drugs. Buprenorphine, as with Subutex, binds to the opioid receptors in the brain to ease withdrawal symptoms; in Suboxone, taken orally as prescribed, the buprenorphine should be the first medication to kick in. However, if the person attempts to crush the pills and inject or snort them, in order to get high, the naloxone in Suboxone should block the binding of buprenorphine to those receptors, so the person does not experience any level of intoxication and instead begins to experience withdrawal symptoms.
How Is It Supposed to Be Used?
As a maintenance therapy, Suboxone should be taken regularly, as prescribed. The doctor and patient will work together to reduce the dosage, slowly over time, so the person safely ends their physical dependence on narcotics. It is not designed for “as-needed” use or to overcome cravings. It should only be taken in conjunction with a doctor’s oversight.
How Is It Abused?
Despite the addition of naloxone, some people find ways to abuse Suboxone. People who have lost their tolerance to opioids or who have not yet developed a tolerance to opioids can experience a mild high if they take Suboxone. Also, people who receive this medication as a maintenance therapy may attempt to inject or snort the drug in large enough doses to bypass the naloxone. Naloxone has a shorter half-life than buprenorphine, so eventually the buprenorphine may kick in if there is enough of the drug in the person’s system.
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Treatment for Abuse Issues
In theory, neither Subutex nor Suboxone can be abused very successfully; however, some people who are struggling with opioid addiction may attempt to abuse these medications. It is unlikely that a person who has never taken narcotics before will attempt to abuse these drugs, but buprenorphine creates a high more effectively in people who have no tolerance for opioids. Regardless, both buprenorphine/Subutex and Suboxone are potential targets for abuse because buprenorphine binds to the opioid receptors in the brain. If abuse of either Suboxone or buprenorphine is occurring, enrollment in a complete rehabilitation program is the best course of action to facilitate safe withdrawal and comprehensive addiction treatment.