Suboxone is the main form of buprenorphine that is used in The United States for opiate detox treatment.
Suboxone is a combination medication containing both buprenorphine and naloxone. It's the buprenorphine that is doing the work to help with
detox. So what is the naloxone and why even bother including it?
This has to due to legal regulatory issues. You see, the buprenorphine itself is still an opiate that does have the potential to be abused.
Sure, its weaker than most of the typically abused opiates, but nevertheless, it still has the potential as a drug of abuse.
So the DEA and FDA were concerned about allowing physicians to prescribe the buprenorphine by itself. They wanted to make sure that it didn't
fall into the hands of people who just wanted to sell it on the street.
So here is where the naloxone comes into play. (Naloxone also goes by the brand name Narcan.) Naloxone is a straight opiate receptor
blocker that works if taken by injection. By putting it in the Suboxone formulation, it makes people think twice about injecting the crushed up
pill. Because if they do and they are addicted to any other opiate they will go into full blown withdrawal - the naloxone will be activated. And
needless to sat they won't be happy.
Do I Need To Worry About The Naloxone in Suboxone?
In most cases you have nothing to fear. The amount of naloxone that is absorbed when you take the pill under your tongue is small. And once
you are over the initial induction phase (starting on the medication) there is rarely a need for concern.
Now if you are addicted to a large amount of a long acting opiate, such as Oxycontin or methadone, then using the Suboxone formulation may not
be right for you. The naloxone may have an effect of worsening withdrawal. So in these cases physicians often go first with the Subutex
formulation because it does not contain any of the naloxone. Ofcourse, which form of buprenorphine you should use can only be determined by
your personal physician.
What Is The Suboxone Detox Procedure?
Exactly how the Suboxone will be used is determined by your treating physician. Here I'll discuss some important general guidelines to
mentally prepare you for the process.
The first thing that you must keep in mind is that Suboxone has both stimulating and blocking actions on your opiate receptors. For this
reason you should NOT start the medication while you are still actively on your opiate. If you do you run the risk of the buprenorphine
(Suboxone, Subutex) actually throwing you into acute withdrawal. Believe me, you do NOT want this to happen.
So with my patients, the have to have a period of time where they are off the opiate they are abusing and actually start to experienece some
withdrawal. When this happens, it means that enough of their brain's opiate receptors are no longer being stimulated by the opiate and the risk
of the suboxone throwing them into full blown withdrawal is not a factor. IMPORTANT: Only your treating physician can determine when the right
time is for you to initiate the buprenorphine treatment.
How long you will need to be off your drug is really dependent on multiple fatcors. One of these factors is the amount and type of opiate
Short Term Mild Discomfort, Long Term Gain
Other Suboxone treatment providers may not mention this to you, but I will.
In order to get the maximum benefit from this treatment, you must be able to "deal with" the first hours of having some withdrawal symptoms.
These hours - between stopping your drug and starting the Suboxone - is the period where there will be some discomfort. Exactly how long it
will need to be, and how much opiate withdrawal you will need to be in can ONLY be determined by your treating physician.
But don't panic! The initial withdrawal is short lived and in some cases other medications may be used to keep you comfortable. And
then once the suboxone is started, you will start to get significant relief within a short period of time of starting it.
And you will be well on your way to addiction recovery.
Your Physician Will Work With You To Determine The Dose Just Right For You
Everyone is different as far as the dose of Suboxone they need. It's likely that you will need to be in contact with your physician by phone
over those first few days so the dose can be gotten just right. Your physician might schedule frequent in-office visits the first week or so of
the treatment process.
It's important to have a Suboxone Doctor who is available to you those first few days. In my practice, my patients are asked to call
me and "check in" at least twice a day for the first several days. And I'm know to get back to my patients ASAP to guide them through this
How Long Does A Suboxone Detox Take?
This also depends on the amount of opiates you are using, and whether they are short acting or long acting. For the shorter acting opiates -
Vicodin (hydrocodone), Codeine, Percocet, heroin - a complete detox can be done in a few weeks.
Yes, there are some docs who do it ultra quick - some in just a fews days. I don't recommend this and find that it is uncomfortable for the
patient. And also, what is the ultimate rush. I always recommend taking the extra time and do the process as comfortably as possible.
For the longer acting opiates - Oxycontin (oxycodone), methadone, MS Contin - it can tale longer to get you fully stabilized on the
medication. And for these drugs, it's sometimes better to use the Subutex form.
How Do I know If Suboxone Maintenance Is Right For Me?
Suboxone maintenance is where you stay on the medication after being detoxed. It's a way to help eliminate or at least
minimize cravings for those with longer term opiate addictions who have a history of relapses. Discover more about buprenorphine
maintenance by clicking on this link: Suboxone Maintenance
Click this link to discover the Suboxone Treatment Options offered by Dr. Gilman