What Is Subutex?
Subutex is one form of a drug called buprenorphine. It helps people who are overcoming an addiction to opioids. Buprenorphine is one aspect of a complete treatment program that includes counseling, lifestyle changes, compliance monitoring and more.
Some people with opioid dependence have a condition called opioid use disorder. Buprenorphine has approval from the Food and Drug Administration as part of Medicated Assisted Treatment for OUD. It is the first drug to treat OUD that physicians can prescribe or dispense in their offices, making it highly accessible to OUD patients.
How Subutex Works
Buprenorphine is in a drug class called mixed opioid agonist-antagonists. It is an opioid that works by stopping other opioids. This process happens in two steps:
- Buprenorphine displaces other opioids from brain receptors.
- It binds to those receptors so that other opioids cannot attach to them.
While Subutex is an opioid, it does not mean that the physician is substituting one addictive drug for another. The dose used during treatment does not create the addicting “high” of illicit use. Instead, it reduces withdrawal symptoms and opioid cravings. It also restores balance to the brain chemistry that addiction can knock out of balance.
How Opioids Work in the Body
Opioids are drugs that work by binding to opioid receptors in the nervous system, especially the digestive tract and brain. They reduce the perception of or reaction to pain by triggering an abnormal dopamine release. Dopamine is a neurotransmitter that associates with learning, rewards and pleasure.
Doctors prescribe opioids to patients to manage pain. Prolonged opioid use changes the chemistry in the brain, however, and people taking the drug may want to continue using it to maintain dopamine levels.
Side Effects of Opioids
Aside from reducing pain, opioids can have side effects that include:
- Nausea and vomiting
- Respiratory depression
Opioid Use Disorder
The crisis began when legal prescription opioids triggered a wave of deaths in the mid-1990s. A second wave began when the heroin market attracted people who were already addicted. With the introduction of illegal synthetic opioids, a third wave took place.
Opioid use disorder differs from other substance abuse disorders. Opioids cause physical dependence in as little as 4-8 weeks. Withdrawal symptoms can be severe, motivating people to continue taking the drug despite the adverse effects.
OUD is a relapsing disorder. Even if patients stop using opioids for years, they still have a chance of returning to using the drug.
Opioid Use Disorder Symptoms
Symptoms of opioid use disorder include:
- Taking increasing amounts of the drug or taking them for longer than intended
- Going to great lengths to obtain the drug
- Continuing to use opioids despite the problems that develop with relationships, work or school
- A strong desire or inability to stop using opioids
- Using the medicine in risky situations
More than half of people with opioid use disorder say that they go to multiple pharmacies so that the staff doesn’t know how many pills they take each month. They also report going to several doctors to obtain multiple prescriptions. Some report that they steal the drugs or get them from family members or friends.
Healthcare professionals diagnose patients with OUD when they meet specific criteria within a 12-month period. The severity of the condition depends on how many criteria are present in the patient.
How Buprenorphine Helps People in Drug Rehabilitation
Many kinds of drugs have a ceiling effect on the body. At a certain point, the drug’s effect hits a peak. Taking more of the drug does not increase its effect. Opioids are one of the drug types that have a ceiling effect. Over-the-counter aspirin also has a ceiling effect.
Pros and Cons of the Ceiling Effect
The ceiling effect can cause people to become dependent on opioids. They try to take more of the drug to continue the opioid’s actions. However, once the drug’s effect plateaus, they no longer get the same experience.
The ceiling effect can also work in favor of someone going through drug rehabilitation. Buprenorphine is a partial agonist. It creates a ceiling effect by partially activating and partially blocking opioid receptors. Therefore, it is most effective in patients who have not yet built a high tolerance to opioids.
Buprenorphine as Part of a Complete Treatment Program
While buprenorphine is an opioid, it is less dangerous than recreational opioid drugs. The drug counteracts other opioids in a safer, controlled manner as patients complete their rehabilitation under the care of a physician.
Buprenorphine is considered safer than methadone because it is a partial agonist. It has less chance of causing respiratory depression, and an overdose may be less dangerous. Physicians may allow patients to take Subutex at home rather than administer it at a clinic for these reasons, giving the patient more freedom and flexibility.
However, patients must understand that taking Subutex is only one piece of a complete rehabilitation program. Buprenorphine and other drugs to treat substance abuse are approved as one part of the Medicated Assisted Treatment of drug dependencies.
Medicated Assisted Treatment for Opioid Addiction
MAT includes behavioral and counseling therapies in addition to medication therapy. Its primary purpose is to treat people with opioid dependence. MAT reduces the need for inpatient therapy in some cases.
Therapists and professionals design the program to fit the individual. MAT has demonstrated clinical effectiveness by:
- Improving treatment retention
- Increasing patient survival rates
- Decreasing illicit opioid use and criminal activity
- Improving outcomes in patients who are pregnant
- Helping patients find gainful employment and live a self-directed life
Because MAT is a personalized program, patients may need different levels of care at various times. Programs may include inpatient therapy, intensive outpatient therapy, peer support and access to medication. Addiction is a chronic condition; long-term care meets patients where they are and provides what they need at that particular time.
How To Take Subutex
Subutex is a form of buprenorphine that the patient takes sublingually or under the tongue. Sublingual drugs work faster than oral medications because they do not have to go through the digestive system to start working. The drug dissolves quickly, and the bloodstream absorbs its active ingredients.
Because of their fast action, sublingual drugs offer an advantage in health emergencies such as:
- Chest pain
- Opioid addiction
A doctor will instruct the patient on taking Subutex. Most patients take it once a day. The patient places the medication under the tongue for five to 10 minutes, allowing the tablet to dissolve completely. The patient should not chew the tablet. Chewing and swallowing Subutex causes the medication to enter the body through the digestive system. This makes the drug less effective as the body must digest it before it starts working.
After the medicine dissolves, the patient should swish the mouth with water and swallow it. This step cleans the drug from the teeth while ensuring the patient receives the total dose. Patients should see a dentist during Subutex treatment. A dental health professional can monitor the patient’s oral health and address any issues during treatment.
The Dangers of Injecting Subutex
Injecting or “shooting up” Subutex can cause severe withdrawal symptoms. However, injecting it can also be very dangerous or even fatal, especially in combination with other opioids, depressants or benzodiazepines.
Taking Buprenorphine at the Most Effective Time
The optimum time to begin buprenorphine treatment is when withdrawal symptoms from other opioids begin. Starting buprenorphine too soon can cause the drug to produce withdrawal symptoms in the patient.
Patients should take the medication at the same time each day. Doing so helps the patient remember to take it and keeps a steady, regular dose in the body.
Side Effects of Subutex
Opioid drugs can cause constipation. They cause stool to move slower through the digestive system. As movement slows, the body absorbs water from the stool, making it drier and harder to pass.
Patients using Subutex may need to take laxatives, eat more fiber, drink plenty of water, and exercise to combat constipation.
Other side effects of Subutex include:
- Dizziness and lightheadedness
Patients should speak to their healthcare providers if side effects are problematic.
Serious side effects are rare, and most patients use Subutex without experiencing them. However, patients should seek medical attention right away if they have the following:
- Severe dizziness or fainting
- Severe mood changes
- Signs of liver damage, such as dark urine or yellowing eyes and skin
- Agitation, confusion or hallucinations
Patients may have other severe side effects not listed above, so they should get medical help immediately if they experience any other severe symptoms.
Mixing Subutex With Other Drugs
Subutex can cause severe and possibly fatal side effects when taken with other drugs. The patient may experience difficulty breathing or an irregular heartbeat.
Patients must be honest with their physicians about any other drugs they are taking, including depressants such as alcohol or marijuana. Taking Subutex in combination with depressants can increase the side effects of drowsiness or dizziness.
Other drugs can also interact with Subutex, so patients should provide their healthcare providers with a complete list of prescription and nonprescription drugs they take. Subutex can react with the following:
- Other mixed opioid agonists-antagonists
- Other opioid pain relievers
- Medications for anxiety or sleeping problems
- Muscle relaxers
- Cold medicines or allergy medications that cause drowsiness
Stopping Buprenorphine Treatment
Physicians can work with patients on stopping buprenorphine treatment. Stopping the drug suddenly can cause unpleasant withdrawal symptoms. The doctor may lower the dose gradually to reduce the chances of this phenomenon. In the meantime, patients should tell the doctor or pharmacist if they experience withdrawal symptoms such as:
- Anxiety or restlessness
- Mood changes
- Nausea or diarrhea
- Sweating or muscle aches
- Thoughts of suicide
When To Avoid Taking Subutex
Like any other drug, Subutex has contraindications for some patients. People with chronic hepatitis B or C or liver or gallbladder problems may need to avoid the drug. People with respiratory issues or decreased lung function may also need to avoid taking Subutex.
Doctors may advise patients with low blood pressure or heart irregularities to avoid taking Subutex. Patients with thyroid issues, chronic obstructive pulmonary disease, seizures or sleep apnea might not be candidates for the drug.
People with a history of toxic psychosis or psychosis after sudden alcohol withdrawal might not be candidates for Subutex.
These conditions are only a partial list of possible contraindications. Patients should speak to their healthcare providers and tell them of any preexisting conditions and known health problems. The doctor can determine if the patient is a candidate for Subutex treatment.
Generally, physicians advise women who are pregnant to avoid taking Subutex. If a patient is breastfeeding, the doctor may choose to monitor the baby during treatment or advise against taking the drug.
Children younger than 16 years of age should not take Subutex. The drug presents dangers to children. Patients who take Subutex should take precautions to prevent children from finding or taking the medication.
Subutex as Part of a Holistic Recovery Plan
Subutex can bring much-needed assistance to patients who are recovering from opioid dependence. The withdrawal phase can feel overwhelming, painful and unbearable. When used properly, mixed opioid agonist-antagonists can help patients stop taking illicit opioids while getting relief from severe withdrawal.
However, Subutex is only one piece of a multifaceted treatment program. Patients who are in recovery need more than physical help. They also require emotional and mental assistance. A holistic approach to recovery gives recovering individuals a good chance of success.
Clean Recovery Centers Can Help With Opioid Dependence
Opioid addiction can happen to people from all walks of life. The disorder knows no boundaries of race, gender, class or economic status. Unfortunately, many patients become addicted after taking opioids for legitimate reasons, such as pain control. Clean Recovery Centers provide a nonjudgmental and holistic treatment plan, establishing a program that fits the individual.
You don’t have to go through recovery alone. If you or a loved one is dealing with opioid dependence, call us at Clean Recovery Centers today. Let us walk with you or your loved one down the road to recovery.