How Does Suboxone Work: Identification and Mechanism of Action

Suboxone is a prescription drug provided to people with an addiction to opioids. This medication is a life-saver for millions of Americans who struggle to abstain from opioid use due to painful withdrawal symptoms. Unlike methadone, which has federal restrictions surrounding who can dispense it, Suboxone can be prescribed by most physicians, though it often isn’t. This guide will teach you how Suboxone works, standard dosing information, who should and shouldn’t use it, and its cautions.

What is Suboxone?

Suboxone is a prescription medication used to treat opioid withdrawal and opioid use disorder (OUD).[1] This medication contains two active ingredients: buprenorphine and naloxone. Buprenorphine is a partial opioid agonist, so it produces the same effects as a full opioid — like heroin — though less pronounced.[2] Naloxone is an opioid antagonist, meaning it blocks the effects of opioids.[3] Unlike buprenorphine, naloxone is only activated if the user injects the medication instead of using it orally.[1] This discourages the user from misusing Suboxone. Suboxone is available in sublingual film form and contains one of the following formulations:[1]

• 2 mg buprenorphine with 0.5 mg naloxone
• 4 mg buprenorphine with 1 mg naloxone
• 8 mg buprenorphine with 2 mg naloxone
• 12 mg buprenorphine with 3 mg naloxone

Dosing and Administration

Suboxone is administered daily as a sublingual or buccal film.[4] To take this medication sublingually, the film is placed under the tongue and allowed to dissolve.[4] For buccal administration, the film is placed inside the cheek and allowed to dissolve.[4] Dosing depends on the type of opioid the patient is dependent on and whether they’re experiencing withdrawal. Patients in opioid withdrawal with a short-acting opioid dependency:[4]

• Day 1: A divided dose of up to 8 mg/2 mg Suboxone
• Day 2: A single dose of up to 16 mg/4 mg Suboxone.

For patients needing maintenance treatment:[4]

• Daily single dose 16 mg/4 mg Suboxone

Patients with a dependency on long-acting opioids or methadone are provided with buprenorphine monotherapy instead of Suboxone for the first and second days of treatment.[4]

How is it Prescribed?

The manufacturers of Suboxone state that “Suboxone should be used as part of a complete treatment plan that includes counseling and psychosocial support.” [4] Therefore, most people with an OUD receive it in a medication-assisted treatment program during and after detox. Some might also receive it as a prescription for continual care after treatment.

What Are the Side Effects?

Suboxone use is associated with several mild side effects. However, some rare and serious side effects can occur. These are more likely to affect individuals allergic to Suboxone ingredients or have preexisting conditions affecting the heart, liver, or lungs. Common side effects include:[1]

• Headache
• Nausea
• Sweating
• Constipation
• Vomiting
• Fluid retention in the arms and legs
• Difficulty sleeping
• Numbness in the mouth
• Redness in the mouth
• Burning tongue
• Tongue pain

In addition to the above-listed symptoms, some people experience symptoms of opioid withdrawal that include:[1]

• Shaking
• Stomach pain
• Diarrhea
• Restlessness
• Irritability
• Anxiety
• Body aches
• Runny nose

Rare and serious side effects include:[1]

• Low blood pressure when standing
• Impaired liver function
• Adrenal gland functioning
• Sleep-related breathing disorders

Allergic reactions to Suboxone include rashes, hives, and itching. Note: If you are pregnant or plan to become pregnant, speak to your doctor before using Suboxone. The effects of Suboxone on a fetus are unknown. However, in animal studies, evidence of obstructed labor and fetal death was observed.[1]  Buprenorphine remains a better option for pregnant women with an OUD, as it has been extensively studied.[1]

How Does Suboxone Work for People with Opioid Use Disorder?

People with opioid use disorder (OUD) have a dependency on opioids and an inability to quit without experiencing withdrawal symptoms. According to the National Library of Medicine, more than 2.1 million Americans have an OUD.[5] This figure incorporates those experiencing opioid dependence and those with a full-blown addiction. Chronic relapses mark the latter after abstinence. The mainstay treatment for an OUD is medication-assisted treatment (MAT). MAT involves the use of FDA-approved medications like Suboxone in combination with behavioral therapies and counseling to reduce opioid cravings and the risk of relapsing after quitting.[6] MAT treatment can last anywhere from several months to several years. The ingredients in Suboxone bind to receptors in the central nervous system, which provide different benefits when treating OUD.[3][8] Buprenorphine produces euphoric effects similar to that of full opioids, though much weaker. As such, this ingredient diminishes opioid cravings and withdrawal symptoms.[2] Naloxone blocks the effects of opioids and is often provided to reverse an overdose.[7] When combined with buprenorphine, this ingredient prevents a full high in people who misuse Suboxone.

Can You Become Addicted to Suboxone?

According to the National Alliance on Mental Illness, taking Suboxone for an extended period can result in physical dependency.[1] Dependency occurs when your brain and body adjust to the medication. If this happens, you may experience withdrawal symptoms when stopping. However, these withdrawal symptoms are not as severe as those associated with full opioids like heroin or methadone. When someone becomes dependent on Suboxone, they may use more than they should or seek out ways to obtain it illegally when it is no longer prescribed. To avoid developing an addiction, physicians are advised to monitor their patients for conditions that point to diversion or progression of opioid dependence, as well as addictive behaviors. These behaviors include:[9]

• Doctor shopping to obtain more Suboxone
• Continuing to use Suboxone despite no longer needing it
• Using Suboxone in an illicit manner
• Uncontrollable urge to use Suboxone
• Continuing to use Suboxone despite negative consequences
• Running out of their Suboxone prescription before the time prescribed

Suboxone manufacturers advise physicians to avoid filling multiple Suboxone prescriptions for patients who don’t follow up as a way to avoid misuse and abuse.[4]

Can Abruptly Quitting Suboxone Cause Withdrawal Symptoms?

Abrupt cessation of Suboxone can lead to withdrawal symptoms. However, this is more likely to occur in individuals who misuse Suboxone parenterally and have a dependence on full opioids like morphine.[4] Nonetheless, buprenorphine, a main ingredient in Suboxone, carries the risk of precipitating withdrawal when abruptly discontinued, though the symptoms are often milder than withdrawal from full opioid agonists.[4] Prescribers gradually taper the dose of Suboxone to avoid the user’s risk of withdrawal. The exact taper schedule is up to the prescriber, as there is no standard schedule.

Is There Treatment for Suboxone Withdrawal?

Behavioral therapy and support can help aid Suboxone withdrawal, but the best way to address Suboxone withdrawal is often reinitiation at a lower dose followed by a taper schedule. However, if the person is experiencing life-threatening complications, which is rare, additional support may be necessary to avoid further complications.

Can You Overdose on Suboxone?

Taking more Suboxone than prescribed can lead to an overdose. Suboxone overdose causes life-threatening complications that require immediate medical care.[10] These symptoms include pinpoint pupils, sedation, respiratory depression, hypotension, and death. Anyone experiencing a suboxone overdose will be monitored in a medical setting and provided with supportive care, including ventilation, oxygen, IV fluids, or prescription medications.[10] It’s important to take Suboxone as prescribed to avoid the risk of an overdose.

Why Does Suboxone Contain a Black Box Warning?

The United States Food and Drug Administration places a black box warning on any medication that can cause severe adverse reactions or death. In the case of Suboxone, the FDA found that it contains opiates. When someone combines an opiate medication with a benzodiazepine like alprazolam, it can result in adverse effects due to its action in the central nervous system.[1] This combination can cause difficulty breathing or even death.

How Can I Receive Suboxone for Opioid Treatment?

The first step in overcoming an opioid addiction is detoxification, which helps your body process and eliminate opioids. Since withdrawal can be quite intense, it’s important to undergo this process under medical supervision. In a medically supervised detox program, individuals receive supportive care along with FDA-approved medications like Suboxone, which can help ease withdrawal symptoms. This comprehensive approach ensures a safer and more comfortable detox experience. The next step is to enter a treatment program that includes behavioral therapy and counseling. Most inpatient, partial hospitalization, and outpatient programs provide these services as part of an opioid use disorder program. Other services include experiential programs like music and adventure therapy or peer support groups. If the program coordinator determines that Suboxone is a good fit, you will receive it during treatment, and a prescription will be provided upon leaving for continual care. Disclaimer: Before receiving Suboxone treatment, consult with a mental health professional to determine if you require additional treatment for your opioid use disorder. Some people with OUD suffer from co-occurring mental health conditions like depression or anxiety. These conditions require additional support alongside OUD treatment.

Finding Suboxone Treatment in Tennessee for an OUD

If you or someone you know has an addiction to opioids and could benefit from Suboxone therapy as part of an OUD treatment program, contact Southeast Addiction Center TN. Our fully accredited facility provides evidence-based services like cognitive behavioral therapy and medication-assisted treatment for individuals looking to overcome their dependency on opioids. Call us today to discover which programs could help you achieve lasting sobriety.