What is Suboxone?

Suboxone patch on the arm

If you're reading this article chances are you or someone that you know is probably considering Suboxone maintenance. Before signing up for the Suboxone program, it’s important that you know and understand what Suboxone is and how the medication works.

How does Suboxone work?

Suboxone is a brand name for a medication that’s used for opioid maintenance therapy (OMT.) Suboxone has two kinds of medicine in it.

  • Naloxone is chemical that used to reduce opioid overdoses and it’s included in the Suboxone.
  • Buprenorphine is a partial opioid agonist (more on that later.) This is used to ease withdrawals.

These two medications work in very different ways.

Naloxone is a potent opioid antagonist. This means that it deactivates the opioid receptors. Since it’s got a fairly strong binding affinity (the strength with which a particular drug attaches to the receptors) it’s able to reduce overdoses by removing other opioids from the receptors. This is because its binding affinity is higher than that of most other opiates.

Ironically, buprenorphine has a higher binding affinity than Naloxone. This means that taking the two drugs together basically eliminates the efficacy of the Naloxone, which is now included largely as a way to continue extending the patent of Suboxone. Pure buprenorphine medication is marketed as Subutex, and another medication with nothing but buprenorphine wouldn’t be allowed on the market.

Taking suboxone prevents you from using other opiates. It was initially thought that Naloxone was the drug responsible for this, since it’s an opiate antagonist. This is not the case.

The buprenorphine in suboxone is what’s responsible for preventing use of other opiates. It’s got an incredibly strong binding affinity and it can kick pretty much any other opiate off the receptors. However, as we mentioned earlier, buprenorphine is only a partial agonist.

A full agonist stimulates the receptors to their fullest extent. This means that drugs like morphine and fentanyl, which have higher levels of agonism, will provide much more of an opiate effect than buprenorphine. However, since buprenorphine has a higher binding affinity, it will be able to bind to the receptors - regardless of whether there are other opiates there - because they have lower binding affinities.

So how does that prevent users from doing other opiates?

Buprenorphine has a very long half-life. The half-life is the time it takes for the body to excrete 50% of a drug - for buprenorphine, that’s between 20 and 60 hours.

Since it’s generally prescribed to be taken multiple times a day, buprenorphine builds up fairly quickly in the body. Since it has high binding affinity, it occupies the entire receptor, but since it is only a partial agonist, it doesn’t activate the entire receptor. This means that you can’t put any more opiates in the receptor because it’s clogged full of buprenorphine, which is only halfway activating it.

This just sounds like being on opiates all the time.

That’s what opiate maintenance therapy is for. It’s considered a last resort for people who have been unsuccessful with trying to quit doing opiates by themselves and who have had no success in traditional rehab programs.

  • Being on an OMT allows the user to return to a functional life, without having to deal with the drug underworld - doing illegal transactions, having to cheat and steal for money, having to lie to employers (if they still have any) and family. It allows them to work towards developing a stable life first, at which point they can choose to get off Suboxone.
  • Suboxone is developed in a way that makes it much easier to wean off of than other opiates, including Methadone. Methadone is the other most popular drug for opioid maintenance therapy, but the physical dependency caused by Methadone is more severe than that of Suboxone.

Are there any risks to consider when taking Suboxone?

Yes. The first and most prominent risk is taknig the medication too soon. Since buprenorphine has an incredibly high binding affinity, you shouldn’t take it until you’re experiencing full withdrawal from the opiates you’ve been taking. If you take it too soon, it will send you into precipitated withdrawal.

Precipitated withdrawal occurs when a less potent opioid with a higher binding affinity kicks all of the other opiates off your receptors. You’re immediately sent into full withdrawal which is generally considered to be much more severe and painful than regular withdrawal. For this reason, and depending on the opiate you’re addicted to, it’s recommended to wati between 24 and 60 hours before taking Suboxone.

The other thing to consider when taking Suboxone is that your doctor fully understands your situation. It is possible to use Suboxone to do a medically oriented wean off of illegal opiates. However this is not the same process as going onto opioid maintenance therapy, and many doctors fail to isolate the issue.

  • If you want to use Suboxone to wean off opiates, and be completely clean, do not let your doctor prescribe you more than 2mg a day unless it’s absolutely necessary. The standard dose is an 8mg tablet, sometimes twice a day, and this is way more buprenorphine than you need. (In all actuality, this is more than almost anyone needs - there are very few opiate problems so severe that they would require 8mg of buprenorphine to ease withdrawals, unless you were on an intravenous morphine drip for several years.)
    • Keep this in mind when talking to your doctor. If you take any more than 4mg a day for more than a couple days, you’ll end up much more addicted to buprenorphine than you ever were to other opiates.
    • Most opiate habits can be completely ended with a single 8mg Suboxone pill if it’s split up into 4 pieces and one piece is taken daily. Ask your doctor if he’ll consider this.

In conclusion

Suboxone is a very powerful, very useful, and very misunderstood medication. It has a lot of practical clinical applications, but unfortunately the way it’s distributed and spoken about leads to misinformation.

We hope we’ve helped clear up some questions you had about Suboxone, and we wish you luck in your recovery.