Understanding Suboxone Abuse

Ninety-one people die every day from anopioid pain reliever overdose, as reported by the Centers for Disease Control and Prevention, or CDC. The CDC considers prescription drug abuse an epidemic, as drug overdose became the leading cause of injury death in America in 2012.1

In 2015, 33,000 Americans overdosed on opioid pain killers, and half of those overdoses were from a prescription, per the CDC.1 The National Survey of Drug Use and Health (NSDUH) estimated that there were 4.5 million users of pain relievers, such as OxyContin or Vicodin, for non-medical purposes during the month of the 2013 survey and an additional 0.3 million heroin users.2

SuboxoneIn 2002, the U.S. Food and Drug Administration (FDA) approved the use of Subutex and Suboxone, two buprenorphine products, for the treatment of opioid dependency in an attempt to manage opioid abuse. These drugs were the first of their kind to be available through prescription and local pharmaciesas detox agents and as maintenance therapy for opioids. They were also developed as alternatives to methadone, which is dispensed once daily in federally regulated clinics, heavily diverted and often abused.

The Drug Enforcement Administration (DEA) published that 9.3 million buprenorphine products were prescribed and dispensed in 2012.3 These medicines are Schedule III drugs under the Controlled Substances Act. Drug scheduling refers to a drug’s medicinal value versus its potential for abuse and dependency, with one being the highest schedule and five being the lowest. Unfortunately, these drugs are commonly diverted and abused. The DEA published that the System to Retrieve Information from Drug Evidence (STRIDE) reported 10,804 buprenorphine drug seizures in 2012.4 Because the drug has become more readily available through prescription, it has also become more readily available on the street.

Suboxone Specifics

Suboxone contains buprenorphine, a partial opioid agonist and naloxone, a partial opioid antagonist. It is currently available and approved by the FDA for prescription as a sublingual filmstrip in doses of the following:

  • 2 mg buprenorphine/0.5 mg naloxone
  • 8 mg buprenorphine/2 mg naloxone
  • 4 mg buprenorphine/1 mg naloxone
  • 12 mg buprenorphine/3 mg naloxone5

Other forms of buprenorphine/naloxone combination medications have been approved too, such as Zubsolv, which comes in tablet form, and the new Bunavail, which comes in a buccal film that is dissolved on the inside of the cheek.

Opioid agonists activate opioid receptor sites in the brain, creating a calming, sedative and relaxing effect while blocking pain sensations. Partial opioids, like buprenorphine, act on these same receptor sites just to a lesser effect. Buprenorphine also has a longer half-life than many other opioids, meaning that it will stay in the bloodstream longer and remain effective for an extended period of time.

The concept of opioid maintenance therapy is that buprenorphine can be used as a replacement for other full agonist opioids like heroin, methadone or opioid narcotic painkillers. It does not produce the same high as other opioids and can prevent the onset of withdrawal symptoms and cravings during detox. Buprenorphine also has a ceiling effect as an abuse deterrent, meaning that after a certain amount, it will no longer produce any euphoric effects. Abusers of Suboxone report a prolonged buzz, however.

Naloxone is an opioid antagonist, which effectively blocks opioid receptor sites from receiving more opioids. The naloxone is meant to be largely dormant in Suboxone unless the drug is injected. When injected, the naloxone will precipitate withdrawal symptoms, discouraging that method of abuse. Suboxone was originally manufactured as tablets, but manufacturers have since changed to sublingual filmstrips since the tablets were often crushed and snorted or injected. Generic versions may still be prescribed in tablet form, however.
Suboxone as an opioid replacement is intended to deter injection drug abuse, which may increase criminal behaviors as well as the risks for contracting infectious diseases like HIV. The filmstrips are still abused, often taped into children’s coloring books and smuggled into prisons. A jailer in Kentucky screened 50 inmates randomly and discovered that 21 of them tested positive for Suboxone, The New York Times reports.6

Side Effects of Suboxone Abuse

Anytime a prescription medication is used outside of its prescribed intent, or for recreational purposes, it is considered abuse or drug diversion.8 Legitimate Suboxone prescriptions may be diverted or used illicitly around half of the time, according to the National Pain Report, turning it into a street drug that is bought and sold in exchange for money or other drugs.7 Emergency department (ED) visits related to buprenorphine products increased fivefold from 2006 to 2011, and the Drug Abuse Warning Network (DAWN) reported 21,483 ED visits related to the non-medical use of buprenorphine, as published by the DEA.4 Opioids may not be traditional central nervous system (CNS) depressants, but they still slow respiration and have sedative effects. Other side effects of Suboxone abuse include headaches, dizziness, abdominal cramps or vomiting, insomnia, trouble concentrating, impaired motor skills, numbness or tingling and an irregular heart rate.

Suboxone is more difficult to overdose on than other opioids although it is commonly mixed with other drugs or alcohol, which may have devastating consequences. The New York Times reports that from the spring of 2003 through September 2013, Suboxone and Subutex were considered “primary suspects” in 690 deaths worldwide, with 420 of them being in the United States, and half of the American deaths involved other substances.4 When combined with other central nervous system (CNS) depressants, such as alcohol, opioids can suppress breathing to dangerously low levels, which can be potentially life threatening. Over time, the brain and body can become tolerant to the effects of Suboxone, and the user may require higher and larger doses to obtain the desired results.

Suboxone is used in opioid dependence therapy as a tool to taper off shorter-acting full opioid agonists.4 It is also used during detox in doses that are lowered slowly over time in a controlled manner until the individual no longer suffers from opioid withdrawal or drug cravings.

Taking higher doses than prescribed, or more often than prescribed, can build up a dependency instead of having the intended effects of lowering it.

Recognizing Addiction

Medical brain illustrationSubstance abuse makes chemical changes in the brain, interfering with the reward and motivation centers. Suboxone may create a surge of dopamine, which is one of the brain’s neurotransmitters responsible for pleasure. Over time, the brain may start to produce less of this naturally as it begins to depend on the artificial stimulation of the pleasure center. When individuals then stop taking it, they may experience cravings and withdrawal side effects that may mimic flu symptoms and emotional side effects, such as irritability, depression, anxiety, feelings of being on edge and insomnia.

Some of the warning signs to look for if you suspect Suboxone abuse, dependency or addiction may include the following:

  • Taking more than the prescribed dose or for longer than intended
  • Altering the drug in any way
  • Taking Suboxone without a prescription
  • Doctor shopping to obtain prescriptions
  • Withdrawing from family and friends
  • A drop in school or work performance
  • Change in sleep patterns
  • Mood swings
  • Excessive amounts of time spent obtaining, using recovering from the drug’s effects
  • Erratic behavior
  • Financial problems that may be related to buying Suboxone off the street

Drug dependency takes an emotional and physical toll, and addiction is considered a brain disease that requires specialty treatment in order to fully recover from it. It is never recommended to stop taking opioid drugs suddenly as this can bring about uncomfortable withdrawal symptoms and drug cravings. Instead, medical professionals may set up a detox schedule that can help you wean off Suboxone in a controlled and responsible manner. Often, this is best performed in a residential setting with 24-hour medical supervision and care from consulting physicians, ensuring that doses are handled properly and safely. When used as directed, Suboxone can be a useful tool. Often, adjunct medications, such as mood stabilizers or antidepressants, are useful during medically managed detox as well.

Once physical stabilization is established, psychotherapies are useful in helping to develop coping mechanisms to handle potential stressors or triggers that may encourage drug abuse or other self-destructive behaviors. Compassionate and highly trained professionals at The Oaks at La Paloma develop individualized and comprehensive care plans for each patient. With a variety of options, plan coordinators take advantage of the multiple recreational opportunities and amenities available as well as utilize evidence-based treatment models, striving to promote a healthy emotional and physical balance during recovery. Contact an admissions coordinator for more information at our 24 hour, toll-free helpline. Please call today.

1 “Understanding the Epidemic.”Centers for Disease Control and PreventionNational Center for Injury Prevention and Control. 16 December 2016. Web. Accessed 21 July 2017.

2Opioid Overdose.” Centers for Disease Control and PreventionNational Center for Injury Prevention and Control. 10 August 2017. Web. Accessed 21 July 2017.

3Results from the 2013 National Survey on Drug Use and Health: Summary of National Findings.” NSDUH Series H-48, HHS Publication No. (SMA) 14-4863. Substance Abuse and Mental Health Services Administration, 2014. Web. Accessed 21 July 2017.

4Buprenorphine.” DEA. July 2013. Web. Accessed 21 July 2017.

5FDA Approved Drug Products.” U.S. FDA. Web. Accessed 21 July 2017.

6 Sontag, D. “Addiction Treatment With a Dark Side.” The New York Times. 10 November 2013. Web. Accessed 21 July 2017.

7 Anson, Pat. “Suboxone: The New Drug Epidemic?” National Pain Report. 23 September 2013. Web. 21 July 2017.

8Emergency Department Visits Involving Buprenorphine.” SAMHSA. 29 January 2013. Web. 21 July 2017.

9 Sontag, D. “Addiction Treatment With a Dark Side.” The New York Times 10 November 2013. Web. Accessed 21 July 2017.