The idea of use Opioid Replacement Therapy (ORT) in treatment of heroin (morphine) addiction exists from 1964. For many years the drug of choice in treatment for heroin addiction in terms of substitution therapy was Methadone. However, Methadone itself is a full opiate agonist with addictive potential higher than that of Heroin. For that reason Methadone is banned for use in many countries.
Appearance on the drug market the new agents Subutex (Buprenorphine) and Suboxone(combination of Buprenorphine/Naloxone) in 2002 were recognized by addiction medicine society as a qualitatively new step in field of opioid replacement therapy. Subutex/Suboxone are approved by the Federal Drug Administration (FDA) for use in both opioid drug detoxification and long term treatment programs for opioid addiction.
Subutex is a partial opioid agonist. Subutex works by binding to opioid receptors and thus produces the main effects of opioids such as: euphoria, feeling of well- being. respiratory depression and some others, though on a much lower level than those of full opioid agonists like Heroin or Methadone. However, agonist effects of Subutex are enough to enable opioid-addicted people to discontinue use of Heroin (Methadone, Morphine, Hyrdocodone, Oxy-Contin and etc.) without going into withdrawal syndrome.
Unfortunately, due to opioid nature Subutex itself can be addictive, but potential for abuse and dependency are less than those of full opiod agonists.
Subutex has a unique property that makes it ideal for use in opioid detox programs. Subutex produces increased opioid effects up to 32mg, but above that dose there aren’t any additional effects. This is so called “ceiling” effect. In other words, the user can’t get higher by using more Subutex. From this point Subutex has low potential for abuse and overdose from it is unlikely. However, Subutex is dangerous when it is injected. For those individuals who are prone to abuse Subutex through intravenous injections Suboxone ( combination of Subutex/Naloxone in ratio 4:1) is recommended. In case of injecting Suboxone, Naloxone immediately precipitates the very unpleasant opioid withdrawal symptoms. Subutex, Suboxone are prescribed as tablets that are taken sublingually. Due to very low bioavailability of Naloxone by sublingual way, Suboxone doesn’t produce withdrawal symptoms when it is taken as prescribed.
Subutex is used in medically supervised opioid detoxification for individuals addicted on Heroin, Morphine, Oxy-Contin and etc It works by preventing the development of withdrawal syndrome which occurs when the individual ceases taking opiates: severe muscle pain, hot-cold flashes, feeling of deep inner cold, restlessness, anxiety, irritability, insomnia, unbearable craving for drugs, body shaking, stomach cramps, diarrhea and etc.
Drug detoxification methods may differ from each other and could include the number of intervention strategies, but the aim of all methods is the same – to cleanse the body out of addictive substances.
Subutex detox treatment
Subutex detox (subutex treatment) has three basic phase:
- The 1st phase -“induction”. The dosage of Subutex is determined to prevent development of withdrawal from full opioid agonist. It takes about 24 hours. The individual is constantly monitored in a physician’s office.
- The 2nd phase – “stabilization”. The patient has stopped using drug of choice and no longer has withdrawal symptoms. The patient continues to take Subutex during this phase gradually tapering the dosage off to minimum. Usually it takes few weeks.
- The 3rd phase – “maintenance”. The individual is doing well and is taking a steady dosage of Subutex. This phase can last either few days or indefinitely.
Patients receiving Subutex must be carefully and regularly monitored during the treatment to determine the right dosage and pace of tapering.
Candidates for opioid addiction treatment with Subutex must meet the following criteria:
- to agree to Subutex treatment after review of other treatment options;
- to follow safety precautions for the treatment;
- to comply with the treatment;
- to have no contraindications to Subutex therapy.
Unfortunately, Subutex itself can be addictive. It means that the patients after solving their problems with Heroin or Methadone might have to go through a second detox from Subutex. However, from our own experience and numerous studies show that withdrawal syndrome from Subutex is quite moderate comparing to that of Heroin or Methadone. As a rule, it doesn’t require much effort to get through and patients are able to function normally during detoxification from Subutex.
In general, Subutex is a safe and effective pharmacological treatment for opioid addiction. Combined with behavioral and psychological therapy which include individual and group counseling, it lets the patients to overcome their addiction to opiates and live drug free life.