Suboxone, or buprenorphine, is offered by some but not all opiate treatment centers. It’s a partial opiate agonist, and many doctors believe that methadone works well on some patients while Suboxone is a better choice for others.
Buprenorphine was approved by the Food and Drug Administration for treatment in October 2002. It is marketed in two formulations, as Suboxone but also Subutex. People hear that it is a partial opiate agonist, but they don’t really know what that means. Here we’ll clarify the terms agonist, partial agonist, and antagonist and their uses at opiate treatment centers. You need to understand their roles because each category wields a different effect on your brain.
Full Opiate Agonists
First are the full opiate agonists, which are the drugs you have been taking to get high. Your brain carries little receptors made up of protein molecules, and when contacted they generate the kinds of biochemicals that make you feel good. For the person who’s not addicted to drugs, that biochemical production results when the person enjoys a great meal, has some wonderful sex, or experiences another pleasurable activity. The person who becomes addicted to drugs uses full opiate agonists to activate those receptors—heroin, pain pills, codeine, morphine, and the whole list of opiate drugs.
Methadone is a full opiate agonist. However, when administered by the staff in opiate treatment centers, it blocks the receptors in the place of any other drug. This makes a good treatment option because when managed carefully by the clinic physician and treatment staff, it is excreted slowly, so its effects remain in your system longer. Once you take methadone in the morning, you do not feel the urge to take it periodically throughout the day, the way you do with heroin or pain pills. It does not stimulate feelings of euphoria the way heroin will, as long as your dose is stabilized, so the person is able to hold down a job and live a productive life.
Buprenorphine is used at opiate treatment centers for those patients who would do better with a partial opiate agonist. Doctors know that while it can control cravings and withdrawal symptoms, it will not get you high. It also has a longer half-life than methadone, again meaning that it remains in the body longer doing its job.
Many doctors at opiate treatment centers will not administer buprenorphine to someone unless they’ve already tried to kick their addiction using either methadone or abstinence-based counseling. They also consider whether you’ve been taking a long-acting opioid, such as an extended-release pain pill. Those patients are at a higher risk of precipitated withdrawal—a sudden and unpleasant drug-induced withdrawal.
Naloxone and naltrexone are opiate antagonists. Thinking of the word agonist, you can see the prefix ant- for anti-, or against. They work completely against any opiates that you take, reversing their effects.
In Suboxone, a higher amount of buprenorphine is combined with a lesser amount of naloxone. The sole purpose of the naloxone is to discourage those who attempt to abuse opiates. Naloxone alone, and even the small amount contained in Suboxone, will put you into that horrible precipitated withdrawal, which staff at opiate treatment centers describe as very uncomfortable, to be avoided at all costs.
Naloxone is also the drug that’s famous for reversing heroin overdoses in emergency departments. It brings someone out of an opiate overdose quickly and unpleasantly. Bear in mind that when it’s injected outside of a hospital—by paramedics, for instance—its effects may last only a half hour, and so it’s important for the person to get immediate follow-up care.
Naltrexone is also a full agonist, and very similar in chemical structure to naloxone. It is the generic drug used in the brand name injectable drug known as Vivitrol. Most opiate treatment centers consider administering it only to those patients who have been completely clean for a month. Some doctors are also using it for alcoholism.
Opiate Treatment Centers Help You Decide
The most attractive benefit of buprenorphine, according to many clients attending opiate treatment centers, is the ability to get a prescription and take it home with you. It’s not like methadone, which requires treatment for at least 90 days before you can earn take-home doses. If you decide to switch from methadone to buprenorphine, you have to be weaned to a low dose of methadone, and then switch to Subutex rather than Suboxone.
Ultimately, the professionals at opiate treatment centers advise their clients which drug is better for them based on their individual circumstances. Most people who go through the assessment process express their choice to the counselor, but it’s up to the doctor to make the final decision. Either way, the staff will work with you to ensure that you get on the right road to recovery.